Ambulance Pressures
Steve Barclay Excerpts(3 years, 10 months ago)
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The Secretary of State for Health and Social Care (Steve Barclay)
Following the announcement by the Met Office on Friday of a red warning for extreme heat, I would like to update the House on the impact of extreme weather on health and care, the current covid infection situation and our plans for covid and flu vaccines this autumn.
This is the first time in its history that the Met Office has issued a red warning for extreme heat. The warning covers today and tomorrow. In addition, the UK Health Security Agency has issued its highest heat alert. Its level 4 alert, issued to health and care bodies, means that the heat poses a danger to all of us, not just high-risk groups. Although for many the risk from this heat can be mitigated by simple, common-sense steps, the extreme temperature poses a particular risk in respect of cardiovascular conditions, including heart attacks and strokes. Level 4 does not change the contingency plans in place across the health system, only their likelihood.
We have taken a number of steps in response. Cobra has convened several times, including over the weekend and earlier today, to co-ordinate every part of the Government’s response to this emergency, and I have held a series of meetings with the chief executives of ambulance trusts to discuss the specific measures that they are taking. Steps include increasing the numbers of call handlers; extra capacity for ambulances; and extra support for fleets, including the buddy system, so that calls can be diverted to another trust if there are delays in the area people are calling from. We have held numerous meetings with NHS leaders, including the chief executive of the NHS and her senior team, to continue to implement their long-standing heatwave plans. We had a further meeting again this morning. Meanwhile, ministerial colleagues have continued to liaise with our local resilience forums to co-ordinate across both health and social care.
Even before this heatwave, ambulance services in England have been under significant pressure from increased demand, just as they have across the United Kingdom. The additional pressure on our healthcare system from covid-19, especially on accident and emergency services, has increased the workload of ambulance trusts; increased the average length of hospital stays; and contributed to a record number of calls. Taken together, that has caused significant pressures, which are now being compounded by this extreme heat.
We are taking action in a range of areas. In May, NHS England published a tender for auxiliary ambulances to provide national surge capacity to support ambulance responses during the period of increased pressure. Alongside measures in ambulance trusts to assist with call handling and capacity, NHS hospital trusts are taking steps to address handover delays, in the interests of patient safety. On Friday, the NHS medical director, Steve Powis, and the chief nursing officer, Ruth May, wrote to the chief executives of NHS trusts, ambulance trusts and integrated care boards setting out some of the urgent interventions we need to make; most significantly the focus was on improved ambulance handovers and increased hospital bed capacity.
On ambulance handovers, we are asking health leaders to look again at the balance of risks across the system. We know that leaving vulnerable people in the community would have serious implications for patient safety. Equally, we know that keeping people in ambulances for too long carries other risks, especially from heat. NHS leaders are therefore asking hospital trusts to create additional space for new patients in their units. That may involve the creation of observation areas or exploring ways to add additional beds elsewhere in hospitals, including by adjusting staffing ratios where necessary, as we did during covid, and working to identify areas to mitigate additional workload, such as through greater support on wards with pharmacy and administration.
The NHS is executing its urgent and emergency care recovery 10-point action plan, which includes action across urgent, primary and community care to better manage emergency care demand and capacity. The NHS medical director and chief nursing officer both recognise that this will place an additional burden on some staff, so they are asking trusts to increase efforts on staff wellbeing and support. Alongside the measures being taken by the ambulance services and NHS trusts, the UK Health Security Agency is leading on public health comms to reduce the burden on NHS staff by making sure that we do not create unnecessary demand. We can do that by following the common-sense public health guidance and by looking out for others, in particular the elderly and the vulnerable.
With services under so much pressure, we must make sure that 999 calls are reserved for life-threatening emergencies. We must also consider what advice we can get through other services such as NHS 111, NHS online resources and local pharmacists. In addition to the immediate steps to mitigate the pressures on 999 calls, ambulance services and adult social care, we will keep building on our operational response, with particular attention to discharge and expanding on our pockets of best practice.
That is particularly pertinent, given the current levels of covid, which continue to rise. The latest data from the Office for National Statistics shows that the percentage of people testing positive for covid continued to increase across the UK. In England, an estimated one in 19 people tested positive in the week to 6 July, compared with an estimated one in 25 during the previous week, with more than 13,000 patients admitted to hospitals with covid-19.
Given those pressures and the expected pressures this autumn and winter from respiratory viruses, we are taking important steps to further align our offers on covid and flu. On Friday, I accepted the Joint Committee on Vaccination and Immunisation’s recommendations for a covid-19 autumn booster programme, focusing on vulnerable cohorts, including everyone aged over 50. At the same time, I took the decision that we should keep offering flu jabs to more cohorts than we did before the pandemic. Taken together, this will reduce the number of people getting seriously ill this autumn and winter, easing pressure on the NHS at a critical time. Vaccines have always been, and continue to be, one of the best protections we have, both for ourselves and for the NHS.
From this heatwave to the foreseeable pressures in autumn and winter, I will continue to work closely with colleagues across health and social care, as well as with Members across the House, to ensure that we can address the challenges ahead. I commend this statement to the House.
Dr Rosena Allin-Khan (Tooting) (Lab)
I thank the Secretary of State for advance sight of the statement and welcome him to his new role. It would have been helpful if, ahead of the current temperatures, he had responded to our urgent question last week, but I am glad that he is here now.
The Secretary of State claims that everything is in hand, but I know from my own experience and that of colleagues across the country that that is far from the truth. We have already seen ambulance wait times soar and pressure on staff spiral, all while the NHS struggles to find the essential staff needed to deliver patient care. I am sure that everyone across the House will agree that our frontline workers are truly amazing. But if nurses and doctors are so overworked and do not have the time and resources to take care of themselves in this heat, the care that they can give patients will be impacted. The Government must step up and show the urgency that this crisis demands.
The Secretary of State talks of creating additional space for new patients in hospitals. How will that happen—with what money, what resources and what staff? Will the Government try to call those new hospitals, too? Is not the reality that creating capacity elsewhere in hospital really means patients being left in corridors on trolleys or in car parks? Can he assure us today that that will not be the case?
Under the Conservatives, the NHS is simply struggling to cope. A record 6.6 million people are waiting for NHS treatment—and they are waiting longer than ever before, often in pain and discomfort. The people in our thoughts this afternoon are those waiting in queues outside hospitals in ambulances, with soaring temperatures and no air conditioning. If it were dogs or cattle, it would be against the law, but these are people in tropical heat unable to enter hospitals. People with conditions triggered by excessive heat are unable to get an ambulance, because ambulances are logjammed outside A&E. Will the Secretary of State apologise to them and their families?
This situation is impacting mental health, too. People attending A&E experiencing a mental health crisis cannot get a bed in a psychiatric hospital, so they wait in A&E, some of them for more than three days. Why? Because the Government have spent the past decade cutting a quarter of mental health beds.
I worked in A&E over this weekend and saw the amazing work being done by staff to prepare for the record heat. The heatwave and surge in covid cases are putting additional pressures on the NHS. I am glad that the Secretary of State recognised that in his statement. Without doubt, 12 years of Conservative mismanagement and underfunding have left our health service unable to cope, which not only has an impact on patients but hurts staff. Staff morale is at rock bottom. Is it any wonder that 5.7 million days were lost to mental ill health in the NHS last year?
Last week, the Minister of State claimed that the Government had procured a £30 million contract for an auxiliary ambulance service, but, moments later, it was revealed that it was yet to be awarded. Can the Health Secretary confirm whether the Minister of State has issued a correction yet?
On Wednesday, ambulance trusts were placed on their highest possible alert level. A national emergency was declared on Friday and, over the weekend, hospitals were scrambling to increase capacity. Why then has it taken until today for the Health Secretary to step up and show leadership? Can he tell us who he met over the weekend? I do not mean at Chequers; I mean from the NHS. Can he also tell us why the Prime Minister did not think it necessary to chair Cobra today? Just when we thought irony had reached a peak, the Prime Minister spent the weekend partying when he should have been dealing with a health emergency. Has the Secretary of State spoken to the Prime Minister today? The Health Secretary has been too slow. The Prime Minister has not even bothered to turn up and the Government have gone AWOL.
If the Government will not step up now, then Labour will. As temperatures reach a record high, all we are getting from the Government is more hot air. This is a crisis. The country has one message for Ministers: stop squabbling and plotting, do your jobs and get a grip.
Steve Barclay
Let me start with the area on which the hon. Lady was correct, which is that I recognise the increased pressure on ambulances and hospitals. That is why we put in place the long-established contingency plans. Since the heatwave in Paris in 2003, it is the case that each year in May, we put in place our heatwave plans. That is what has been activated. Those plans were refreshed as recently as two months ago and sit alongside the work that has been done on urgent and emergency care, including the 10-point action plan that was set out last September.
The hon. Lady is right: the House as a whole will recognise the significant pressure on the system, which is why we are taking the steps from our contingency plans. It is also why we have put in specific funding, such as: the additional £150 million of support targeted at the ambulance service; an additional £50 million for 111 calls to build capacity; and as she said, an additional £30 million for auxiliary ambulances, which is what the Minister of State, my hon. Friend the Member for Lewes (Maria Caulfield), was referring to in the House last week.
The Met Office and the UK Health Security Agency went to level 4 on Friday. As you will know, Madam Deputy Speaker, I updated the House on the first available sitting day after that. The irony will not be lost on the House that this issue is seen as so important that the shadow Secretary of State for Health and Social Care has failed to turn up to this statement in the middle of a heatwave. [Interruption.] Well, he is not here, which speaks for itself.
The hon. Lady also suggested that these challenges, which are being faced across Europe as a whole, were in some way due to the overall investment in the NHS. I remind the House that, to take the resource departmental expenditure limit alone, RDEL in 2010 was just under £99 billion and last year it was £150 billion. That is a good indication of the significant funding. We could also come on to capital investment, not least with the 40 hospitals programme, part of a £22 billion package to 2030, which underscores this Government’s commitment to investing in our NHS—an investment that, most recently, the Labour party voted against when we brought it to the House.
The hon. Lady asks about an apology for operational levels of performance. I do not know whether she is asking for that apology from the Welsh Government or just from the English Government. She may want to clarify that, given the performance of the Welsh ambulance service under the Welsh Government.
On the hon. Lady’s point about auxiliary, the Minister of State, Department for Health and Social Care, my hon. Friend the Member for Lewes, said in her statement that we had seen improvements in May. I referred to that as context, but on auxiliary in particular I can clarify for the House that a contract is being procured for auxiliary ambulance services and is expected to be concluded shortly.
Finally, the hon. Lady asked what meetings I have held over the less than two weeks that I have been in post. I am happy to share with the House that I have been on visits to four different hospitals, in Whipps Cross, Hillingdon, King’s Lynn and Bedford; I have been out on two different ambulance shifts, been to three different ambulance centres, been out to see GPs to look at boosting access to their services and been to look at life sciences. I have been engaging, and that sits alongside, for example, the meeting with chief execs of ambulance trusts on Saturday, Cobra on Saturday and other such meetings that I have had in the course of my duties.
Finally, the hon. Lady asked about the Prime Minister’s engagement. Just as the Chancellor of the Duchy of Lancaster set out that he was engaging with the Prime Minister in his role chairing Cobra as Minister for the Cabinet Office, I am happy to confirm to the House that I also engaged with the Prime Minister over the weekend, updating him on the health plans we have put in place. He has been closely engaged on the contingency we have put in place.
Madam Deputy Speaker (Dame Rosie Winterton)
I call the Chair of the Health and Social Care Committee, Jeremy Hunt.
Steve Barclay
I am grateful to my right hon. Friend for that warm welcome. I was Minister of State when he was Secretary of State, and hugely valued the expertise, diligence and insight that he brought in that role, which provide useful context as I take on my new duties. He is absolutely right; indeed, he will recall, in 2018, looking in detail at delayed discharge, and work on that key issue continues. For example, on 1 July the NHS launched a 100-day sprint looking at all the known interventions. One issue that he and I have discussed in the past is how to socialise best practice and industrialise innovation at scale, and we are looking specifically at that. There is also a call for expressions of interest in pioneer science to better use tech and innovation on delayed discharge, and of course there is £2.6 billion of investment in the better care fund to support that integration work through the integrated care boards.
Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)
Although I welcome the additional resource in response to the heatwave, it is simply not enough. Does the Secretary of State agree that until the Government address the systematic problems in social care to ensure that it is properly funded and people can be discharged quickly into the community, and we no longer see the revolving door service that is proving so damaging in the sector, we will not truly be able to reduce the pressures on the ambulance service?
Steve Barclay
The hon. Lady brings great practical insight on these issues from her profession as a nurse. The point she raises, as did my right hon. Friend the Member for South West Surrey (Jeremy Hunt), is absolutely right—delayed discharge has long been a key issue. That is why we have made the tough decisions we have on national insurance and why we brought forward the changes on integrated care boards. It is an area of common ground across the House that we need to work better to address delayed discharge, which blocks the pipe and, in turn, delays ambulance handovers and causes problems at an earlier stage. It is a key issue. I have set out a number of practical measures that we are taking, and further work is ongoing.
Tim Loughton (East Worthing and Shoreham) (Con)
On Friday afternoon, I spent a shift with the A&E staff at the fantastic Worthing Hospital, which is clearly being impacted, in particular, by older people affected by the heat. The staff said to me—the Chairman of the Health Committee mentioned this—that more than 15% of the beds are being occupied by people medically fit to be discharged. They also said that a huge amount of their time is being taken up by people with mental health problems, including those being brought in by the police, most inappropriately. What more can be done to make sure that people with mental illness are being looked after away from A&E departments, as is far more appropriate, and to speed up the process of freeing up those beds?
Steve Barclay
My hon. Friend is absolutely right on mental health and where a patient is violent, as I saw for myself on my visit to Bedford, for example, that can be unsettling for A&E. I am happy to have further conversations with him on what measures can be taken. The fact is there is no single intervention in this space; it is a question of looking at the integrated approach. That is what the call for evidence is about. Also key is understanding the data and seeing where it can better target action on areas such as mental health that can have a disproportionate impact.
Daisy Cooper (St Albans) (LD)
It is absolutely right that we limit the amount of time that patients must spend in the back of ambulances, and I welcome that measure, but it is putting intolerable pressure on hospitals. This morning, health leaders told me that they simply do not have the space or the staff, and the one thing they need in the next few hours is more staff. Can the Secretary of State commit himself to ensure that in the next few hours there are no financial or other barriers to the NHS being able to access more NHS bank staff, paramedics and ambulance drivers from the fire service, and, if necessary, from the military?
Steve Barclay
The principle of subsidiarity is that, as part of the extreme heat plans, local trusts make decisions locally on targeting resource, whether that has an impact on outpatients or other services, to meet the increased pressure. The hon. Lady is absolutely right that there is significant increased pressure, as we see in the call volumes coming in to 999 and 111. Part of the contingency plans that are in place is to surge resource, but it is also partly about being clear where risk best sits. At the heart of the letter from NHS medical director Stephen Powis on Friday was the importance of not pushing risk out into the community where it is an unmet need, or into the ambulance, where it is best that patients are, but having that risk more on the ward, where a patient is known and can receive care. Local contingency plans are in place to allocate resource to meet that.
Mims Davies (Mid Sussex) (Con)
I pay tribute to all my Mid Sussex constituents on the frontline of all our emergency services in this extreme heat. They are absolutely continuing their heroic efforts, whether on the NHS backlog, managing discharges, as we have heard, or managing the impact of covid. Following recent media reports, will the Secretary of State note the constraints in certain ambulances, which my constituents have also raised, with cabs being too small and seatbelt use impacted for those over 6 feet tall? The impact of those new ambulances is on the agenda at a meeting for West Sussex MPs with SECAmb—South East Coast Ambulance Service NHS Trust—this Friday.
Steve Barclay
First, I am happy to join my hon. Friend in paying tribute to the work of the local staff in her ambulance trust. She raises an important point about the fleet, and I was very interested in this issue four years ago when I was ambulance trust Minister and discovered that there were, I think, 32 different types of ambulance. When I was out with crews over the past fortnight, one of the issues we discussed was the merits of tailgates so that people are not suffering work absence and musculoskeletal injuries because they are trying to push heavy loads on to an ambulance. I am interested in exploring with her and colleagues how we get the right standardisation and the right fleet in place. Indeed, we have been targeting additional money to support that work.
Matt Western (Warwick and Leamington) (Lab)
Since March, West Midlands ambulance service has been on the highest level of alert, and I understand that it was joined by the other ambulance services across England last week. In May, Mark Docherty, the director of nursing for West Midlands ambulance service, predicted that the service would collapse by 17 August—that is a month away from now—if hours lost by crews delayed outside hospitals kept increasing, which of course they have. Can the Secretary of State give some specific answer on what he is doing to address the issues in the west midlands, and also in our care homes, which are a root problem of trying to get people out of hospitals?
Steve Barclay
The hon. Gentleman is right that the west midlands in particular has been under significant pressure, and 111 ambulance service response times are significantly challenged, which is driven by wider system pressure and delayed handing over of patients. The measures taken through the national support that is going in include handover delay improvements, on which works is taking place across all integrated care boards. NHS England has allocated an additional £150 million to support the system, and an extra £20 million of capital is going into fleet. Given that I am new in post, I am happy to meet the hon. Gentleman to discuss any specific issues about the West Midlands ambulance service’s performance.
Philip Dunne (Ludlow) (Con)
May I congratulate my right hon. Friend on his new role and say how important, given this particular crisis, his previous experience as Minister of State for Health is? He took over that role from me, and he had ministerial responsibility for ambulances.
On Friday, I attended an ambulance summit with other Shropshire and Telford MPs, West Midlands ambulance service and NHS leaders in Shropshire, where we were told that one of the critical issues in ambulance response is the handover wait times at hospitals. Royal Shrewsbury Hospital was averaging two and a half hours for handover in the first two weeks of July, and the Princess Royal Hospital in Telford was at three hours.
The problem is not so much conveyance by ambulance because it is hard to reach patients, but ambulatory walk-ins at our hospitals increasing the volumes of patients being seen in A&E. The problem with that increase in patient volume is patient flow and discharge at the far end. May I suggest that the quick win would be to increase resources for social care, particularly for domiciliary care workers who at present, particularly in rural areas, have to pay for their own transport to get from one patient to another? If we could improve those conditions, it would boost the ability to discharge patients.
Steve Barclay
My right hon. Friend, partly through the direct experience he brings to these issues, highlights the integrated nature of the challenge we face and in particular the importance of getting the right domiciliary care and care home support in place. Part of that challenge in the coming weeks, ahead of any autumn and winter pressure, will be to understand what the capacity is and what the constraints on it are, so that through the integrated care boards we can better focus on unlocking that capacity to relieve the pressure on ambulance handovers, as he sets out.
Rachael Maskell (York Central) (Lab/Co-op)
Older and more vulnerable patients can become medically compromised very quickly in extreme heat. In Yorkshire, category 1 calls can be waiting for 9.5 minutes over the expected time, category 2 calls can be waiting for 18 minutes over, and those with other medical conditions can be waiting 2 hours 41 minutes over. People clearly need support and assessment far earlier. What is the Secretary of State doing to deploy first responders in such areas so that people can get a medical assessment and early intervention far quicker?
Steve Barclay
I broadly agree with the hon. Lady on providing targeted support, particularly to those in domiciliary care; we are working with those in primary care on that. In coming days, that will happen specifically through local resilience forums, but in the medium term it will be more through the integrated care boards. That is part of a wider package of support measures that need to be put in place. It will include working with primary care, looking at mental health support, and looking at what can be done to raise productivity through better use of innovation and technology. We will look at all the interventions available across the board to assist us in dealing with the pressures that she highlights.
Andrew Percy (Brigg and Goole) (Con)
I spent this weekend on duty, in my role with the Yorkshire ambulance service. I remind my right hon. Friend of the important work and extra resilience that community first responders will provide in the next few days, as they are stepped up and attend the most serious 999 calls. The reality is that even before this situation, when attending very serious cases, we were often waiting much longer than we did in the past for back-up from the crew. Will he look at a model that I have pushed before: the advanced paramedic model, which gives paramedics more clinical confidence to discharge patients to their home, and so reduces demand on hospitals?
Steve Barclay
I am happy to look at that, and I thank my hon. Friend for his service locally. I am keen to follow up on his point, because it is absolutely right. From the feedback from ambulance trusts so far, it seems that category 2 average response times were broadly stable at the weekend, but how we triage, how we categorise calls, and what additional support can be given by considering the skills mix are all factors in improving performance.
Helen Morgan (North Shropshire) (LD)
I also attended the meeting on Friday morning about Shropshire’s health crisis, and I echo the comments of the right hon. Member for Ludlow (Philip Dunne) on that. Quite apart from this week’s heatwave, there is increased demand on Shropshire’s ambulance service, and the local team are clearly working hard to find solutions, but I did not feel reassured that they had any quick fixes for this crisis. One of their big problems is with recruiting social care workers; the team say that they have never seen a market like it. What is the Secretary of State doing to address the critical workforce problem in social care, not only in rural areas but across the country?
Steve Barclay
Through initiatives such as the better care fund and the £2.6 billion of investment, we are looking at how to allocate funds in an integrated way. That requires better integration of data between the care sector and the NHS, and that is an area that I am keen to explore.
Lee Anderson (Ashfield) (Con)
I recently had the good fortune to spend a few hours with an ambulance driver from Ashfield who drives for the East Midlands ambulance service. He told me that he is so frustrated, because a lot of the time, the ambulance gets to the caller, and the person simply does not need an ambulance. He raised this with his bosses, but they are scared to admit that. Is it not about time that somebody from the Department of Health and Social Care had an honest conversation with the people who actually do the graft—the drivers and the ambulance staff?
Steve Barclay
I know from conversations in recent days that there has been significant work around dispatch, the assessment of calls and the role of clinicians, particularly in 111. There is further work with frequent callers. I went out with the London ambulance service, and one of our visits was to someone who had had 140 ambulances visit him over the past year and a half. There are initiatives, and work going on, on how we assess calls and get dispatch right, but I am very happy to take forward the comments that my hon. Friend makes.
Chris Bryant (Rhondda) (Lab)
I, too, congratulate the right hon. Gentleman on his new post.
The Chair of the Health and Social Care Committee raised the question of what happens when people are ready to go into the community, but there is nowhere there for them to go. There is an even worse example: people who have major brain injuries, for instance as a result of a road traffic accident. The ambulance staff will get them to the major trauma centre, which will save their life, but if they are to get back their life with any degree of independence, they need a prolonged period of neuro-rehabilitation. Some of that will happen in hospital, but across large swathes of the country, there is nothing—absolutely no provision—outside hospital. With any other condition, we would not expect treatment, once started, not to be finished. How can we make sure that neuro-rehabilitation services, which give people back their life, are available across the whole country, and that there is no postcode lottery?
Steve Barclay
I know the hon. Gentleman is co-chairing, with the Minister for Care and Mental Health, a strategy board looking at these issues, and I would be very keen to explore that with him in due course. There is an opportunity—not just from a health perspective, but from a levelling up perspective—to look at the pockets where there are gaps in the way he sets out, and to see how we can get better coverage geographically as well as address the very real health needs he identifies.
Mark Pawsey (Rugby) (Con)
My constituents attribute the deteriorating response times in Rugby to the decision of the West Midlands ambulance service to close our community ambulance station at the Hospital of St Cross—a decision taken without reference to doctors, councillors, residents or the local MP. Does the Secretary of State agree that decisions of that nature should be made only after consultation and with the support of local stakeholders?
Steve Barclay
I do not know the specific circumstances of the case my hon. Friend highlights, but in general good consultation and engagement with stakeholders will of course lead to better and more informed decision making. Where decisions have been taken and the outcomes proceed in a sub-optimal way, I know from my knowledge of my hon. Friend that he will make such a case in the strongest terms.
Clive Efford (Eltham) (Lab)
It is worth remembering that the 2010 to 2015 Conservative Government took £6 billion out of social care, so it is no wonder that we are facing a logjam. Since 2015, not once have the Government hit their four-hour target at A&E, and it is down to less than 72% on average right now. This logjam is created by the Conservative Government’s mismanagement of our national health service, so what is the Secretary of State going to do to get back to the four-hour target for A&E?
Steve Barclay
This Government are investing in our NHS. That is why the resource departmental expenditure limit, which in 2010 was £99 billion, went up last year to £150 billion. It is why we are investing more than £10 billion in capital this year alone. It is why the NHS will get an uplift of about £38 billion over the five years from 2019-20 to 2024-25, and it is why this Government have invested in our 40 hospitals programme as part of a £22 billion commitment.
Jack Brereton (Stoke-on-Trent South) (Con)
We have seen some serious issues with the West Midlands ambulance service and congestion at the Royal Stoke University Hospital, and it is only a few years ago that we saw people dying in the corridors at that hospital. Will my right hon. Friend look at what we can do to address these issues, and ensure that we do not just move people from queuing outside the hospital back on to high-risk corridors?
Steve Barclay
That specific point about where risk best sits within the system was addressed in the letter from the NHS medical director on Friday. Of course, the best way of addressing that risk is to address the issue of delayed discharge. We are getting people out of hospital through initiatives such as the better care fund, the £2.6 billion of investment and the use of integrated care boards. Their use will enable us to take a more integrated approach to unblocking those who are in hospital unnecessarily, which is not only very expensive but fundamentally bad for their care. It is important that we address delayed discharge as a key priority.
Jim Shannon (Strangford) (DUP)
I thank the Secretary of State very much for his responses to the questions that have been asked. To give an example that I hope will be helpful to him—this is a devolved matter—when one of my constituents fell and badly hurt her leg last week on rocks offshore, she was able to send a photograph of her injury, and as a result an ambulance was dispatched urgently and she was rescued. My concern is about those who are not high-tech enough to send photographs of injuries to prove that they are ambulance-worthy. Can I ask the Secretary of State how it would be possible to triage calls in a way that does not put pressure on people, but addresses the potential misuse of emergency ambulance requests?
Steve Barclay
I am happy to look at any specific issues that flow from the hon. Gentleman’s constituency case. The more we can use tech and innovation better to address those issues at pace, the more that will ultimately lead to better patient outcomes.
Public Health
Steve Barclay Excerpts(4 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office (Steve Barclay)
Throughout today’s debate, we have heard the sincere and heartfelt views of hon. and right hon. Members from across the House. I recognise the strength of feeling, and will turn to each of the statutory instruments for consideration before the House, but before I do, may I recognise the constructive approach taken by the Opposition Front Bench?
We are learning more about the omicron variant each day, but we already know that no variant of covid-19 has spread this quickly. It will become the dominant variant in London in the next 36 hours, and soon across the UK as a whole. It is right that we take a cautious approach to the arithmetic, alongside a strong communications campaign of the sort called for by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom).
Steve Barclay
In a moment.
There is much that we still do not know about this virus, as there is a wide range of opinions on its severity. Hospitalisations and deaths always lag infections by about two to four weeks. We are not at the topping-out point in South Africa, so we do not know what the peak will be, but even a small percentage of widespread transmission will be significant—a point rightly made by the Opposition Front Bench, and the Secretary of State when he opened the debate. This is not, as some suggest, solely an issue for the NHS. Widespread infection and staff absences would have a wider economic impact on areas from our supply chains to our factories.
Chris Bryant
The Secretary of State said earlier that he might be able to provide the House with an update on the issue of whether people who have come back from South Africa and are stuck in quarantine have to fulfil their whole quarantine. I have constituents from the Rhondda—rugby players—who are still stuck. They had already done 10 days of quarantine in South Africa; surely they can be released tomorrow.
Steve Barclay
I will come to that matter directly—not just because they are rugby players, but because it is an extremely important issue.
Dawn Butler
The Minister is absolutely right that we have to do all that we can to stop the spread of the omicron variant. I am sure that, like me, he is encouraging people to take the vaccine and the boosters. Parliament is a really large venue; about 3,000 people work here. Will the Minister confirm that everybody on his side of the House has been doubly vaccinated, and that a covid pass situation will be relevant to MPs, who will be huddled together—hundreds of us—voting today? What protections will MPs have to ensure that we are safe?
Steve Barclay
I am not sure whether the hon. Member has been in the Chamber for the whole debate, but throughout the day there has been consensus across the House on the importance of being vaccinated and of boosters; that has been a point of agreement. Obviously, the management of the House is a matter for Mr Speaker, not for me. As my hon. Friend the Member for Bexhill and Battle (Huw Merriman) correctly highlighted, he and our constituents will continue to be able to access all facilities, as before. I point out to the hon. Member for Brent Central (Dawn Butler) that it is still possible to go to nightclubs, just as it is possible to vote, and these measures will not prevent that.
As well as omicron’s transmissibility, we are also beginning to learn more about the effectiveness of our vaccines against it. Boosters were important before omicron, but they are now critical and, as of this evening, we have delivered 24 million across the United Kingdom. Boosters are, without question, the single most effective thing we can do and plan B buys us more time to get more boosters into more arms. I pay tribute to my hon. Friend the Member for Bosworth (Dr Evans), who, as a GP himself, highlighted the importance of addressing the 15-minute wait period to increase the flow of boosters—a decision that the chief medical officers across the UK have supported. I also concur with my right hon. Friend the Member for North Somerset (Dr Fox), who rightly highlighted that the second dose is important alongside the booster.
The early evidence suggests that a booster dose is extremely effective; analysis by the UK Health Security Agency shows that a booster dose is 70% to 75% effective at preventing symptomatic infection. That is particularly important given the speed at which this infection is spreading, which means that the increase will be sharper, and its impact more concentrated, over a shorter period of time.
The hon. Member for Rhondda (Chris Bryant) raised an issue. The Health Secretary flagged up in opening the debate that he intended to remove all 11 remaining countries from England’s red list as of 4 am tomorrow. The Health Secretary has urgently considered the issue of releasing people from managed quarantine before they have completed the 10-day isolation—a point also raised by the right hon. Member for Exeter (Mr Bradshaw) and a number of Members from across the House. The Government’s decision is that we should permit early release of those who went into managed quarantine before the changes to the red list and require them to follow the relevant rules as if they had arrived from a non-red list country. Anyone who has tested positive will need to continue to stay in managed quarantine. That will require changes to regulations. We will look to implement that as quickly as possible and we will set out further specific guidance for affected individuals imminently.
I turn now to the statutory instruments before the House. The weight of scientific evidence shows that face coverings can make a difference, even if, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said—he is a clinician himself—it is the least that we can do to wear these wretched things. Regulation 1400, which extends the use of face coverings, is a simple step to help slow the spread and I welcome the support of Members. Even those with concerns, such as my hon. Friend the Member for Winchester (Steve Brine), said that they would not oppose such a measure.
It is vital that we draw on our testing capacity to keep Britain moving. Regulation 1415 enables close contacts of confirmed or suspected covid cases who are fully vaccinated to take lateral flow tests every day for seven days. In response to my right hon. Friend the Member for Tunbridge Wells (Greg Clark), the lateral flow tests will be self-reported.
Regulation 1416 regarding entry to venues and events is one I know that hon. Members have given considerable attention. But this is very far from what has been described as a vaccine passport—a point that the Health Secretary made in opening the debate. This measure will mean that a negative lateral flow test is required to get into nightclubs and large events, with an exemption for the double vaccinated. Once all adults have had a reasonable chance to get their booster jab, we intend to change this exemption to require a booster.
Vaccination has been and remains our best line of defence. We have heard many contributions from across the House on making vaccination a condition of deployment for staff in health and wider social care settings. I recognise how emotive this issue is. Whether it is our care homes, our hospitals or other health settings, everyone working in health and social care is there to avoid preventable harm to the people for whom they care. As the chief medical officer has rightly said, people who are looking after other people who are vulnerable have a professional responsibility to get vaccinated, which was a point that another clinician—my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—made.
In closing, I am grateful for all the contributions today. The measures before us will help us to buy time and deliver boosters, which will provide the best protection against this variant. Vaccination, which was already so important before omicron, is now doubly important, especially in those settings with some of our most vulnerable people. I commend the regulations to the House.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. To address the point raised by the hon. Member for Brent Central (Dawn Butler), in the event of Divisions, it is likely that there could be a large number of Members voting in one Lobby this evening, so Mr Speaker has agreed that 12 minutes should be allowed before I call for the doors to be locked. Members should accordingly be aware that they do not need to crowd into the Lobby at the beginning of the vote, as there will be more time to vote than usual.
6.30 pm
The Deputy Speaker put the Question (Order, this day).
Healthcare (International Arrangements) Bill
Steve Barclay Excerpts(7 years, 6 months ago)
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The Minister for Health (Stephen Barclay)
I beg to move, That the Bill be now read a Second time.
This is a short Bill, with six clauses, to enable continuity of healthcare for British nationals and EU citizens after Britain leaves the European Union. It is clearly in the interests of the British public to ensure reciprocal healthcare arrangements continue when we leave the EU, whether that happens through an agreement with the EU itself or through individual agreements with EU member states. By enabling us to implement those arrangements, the Bill will help us to help nearly 200,000 British pensioners living in EU countries to continue to access the medical treatment that they need, and it will mean that the hundreds of thousands of British citizens who require medical treatment each year during holidays in Europe can still be covered for medical assistance when they need it.
The Bill will help to ensure that UK nationals who live and work in EU countries can continue to access healthcare on the same basis as local people. It will mean that EU citizens can be covered for reciprocal healthcare here, so that the UK continues to be a place tourists want to visit and vital workers, such as our NHS workforce, want to live in. The Bill will also mean that we can continue to recover healthcare costs from Europe as we do now.
Henry Smith (Crawley) (Con)
A few years ago, I presented a private Member’s Bill on the recovery of costs under the European health insurance card scheme. More than half of NHS trusts did not record the treating of foreign nationals at all so that they could claim back on those reciprocal arrangements. Can I get an assurance that, under the new arrangements, the NHS will be properly refunded for the care it provides to those from other countries?
Stephen Barclay
My hon. Friend makes an important point. Perhaps I should declare that, when I was a Back Bencher, I tabled a number of parliamentary questions on that very issue, relating to my hospitals and to claiming. We pay out around tenfold what we recover. I will come on to that point, but part of the Bill relates to the NHS’s increased focus on the issue, which he is correct to raise.
Reciprocal healthcare agreements benefit people in all regions and nations of the United Kingdom. The Department of Health and Social Care currently funds and arranges EU reciprocal healthcare for people from England, Scotland, Wales and Northern Ireland. The Bill will allow us to continue doing that, if agreed with the EU. We have been working for some time now with the devolved Administrations and will of course continue to do so to ensure that we legislate for reciprocal healthcare in a way that fully respects the devolution settlements.
We can all agree that access to healthcare is essential both for British nationals living in European countries and for EU citizens living in the UK. The Bill will also allow us to strengthen existing reciprocal healthcare agreements with non-EU countries and explore new arrangements. As the Prime Minister said last night, the negotiations for our departure are now in the endgame and we are working to reach an agreement. As Members would expect, we are continuing to make the necessary preparations for all scenarios. It is in everyone’s interests to secure a good deal, but it is the job of a responsible Government to prepare for all scenarios, including in the event that we reach March 2019 without agreeing a deal.
In the event of no deal, the powers in the Bill will help to implement deals with EU countries that will seek to provide continuity of care for UK nationals and avoid a cliff edge. The powers will enable the UK to act swiftly to protect existing healthcare cover for British nationals in the EU, the European economic area and Switzerland, whether deals are made with the EU or individual member states. That is in the interests of everyone and, most importantly, will benefit millions of UK nationals who live, study, work or travel in mainland Europe.
British people who have paid their taxes in the UK their whole working lives and have retired to Spain, France or other EU countries should not have to worry about healthcare and how much it is going to cost them. Similarly, the millions of British people who travel to mainland Europe each year should be able to do so with the peace of mind that the European health insurance card scheme brings. These schemes are popular across the UK. There are currently 27 million EHIC cards in circulation in the UK, with 5 million issued each year. Reciprocal healthcare arrangements enable UK nationals to access healthcare whether they live in, work in or visit EU countries.
The current arrangements involve EU member states reimbursing one another for healthcare costs. We support UK nationals in the EU by spending approximately £630 million a year on healthcare for British expats and tourists. At present, we recover £66 million each year from EU member states under the same rules, but that amount is increasing as the NHS gets better at identifying EU visitors and ensuring that the UK is reimbursed for care provided, which speaks to the point that my hon. Friend raised. It is a net spend because many more British pensioners and tourists go to Europe than the other way around.
It is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU. The Bill does not affect the UK’s ability to negotiate or enter into international agreements, and the details of any new reciprocal healthcare arrangements will remain subject to negotiation and parliamentary scrutiny.
Until now, the majority of UK-EU reciprocal healthcare has been enabled by EU regulations. Once we leave the European Union, the EU reciprocal healthcare arrangements will no longer apply in the UK in their current form and we will need new legislation to provide for future arrangements. With a deal, the withdrawal agreement will enable the continuation of existing reciprocal healthcare rules during the implementation period, and afterwards for people covered by that withdrawal agreement, but it is not a long-term arrangement for the British public as a whole, does not provide for the event of the withdrawal agreement not being concluded and does not cover healthcare arrangements with countries worldwide.
The UK already has important agreements in place with Australia, New Zealand and many of our Crown dependencies and overseas territories and the Bill will help us to strengthen those, should we wish to, or seek new arrangements with other countries. The Bill underscores the Government’s commitment to reaching a robust reciprocal healthcare agreement with the EU.
This is important and necessary legislation, introduced so that the British public can look to the future with confidence that they will get the healthcare they need, when they need it. I commend the Bill to the House.
The Minister for Health (Stephen Barclay)
With the leave of the House, I thank everyone who has spoken in the debate. This is a short and sensible Bill, which will ensure that the Government have the appropriate legal framework to give effect to a deal in relation to reciprocal healthcare arrangements, which so many of us, both here and abroad, enjoy. I am grateful for the support in principle for the Bill from both sides of the House, including from the Opposition Benches.
The level of interest in and the contributions to the debate demonstrate that it is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU. A number of questions have been raised in the debate, which I will endeavour to answer in my closing remarks. However, as my opposite number, the hon. Member for Ellesmere Port and Neston (Justin Madders), pointed out, we will have an opportunity in Committee to scrutinise those questions in more detail. He raised a number of very pertinent points, which I will be keen to explore with him.
I would like to reiterate the offer I made in a recent letter to all Members of the House to have meetings with me and the team of officials working on the Bill if they want to explore the Bill in more detail. I recognise—this point was picked up by my hon. Friend the Member for North Thanet (Sir Roger Gale)—that this issue genuinely concerns constituents of Members on both sides of the House. I am keen to engage with Opposition Members, the Chair of the Health Committee and other colleagues on the detailed issues they may wish to raise on behalf of constituents.
Mr Philip Dunne (Ludlow) (Con)
I am grateful to my hon. Friend, and I would like to take advantage of his offer, but I would also like to highlight another issue. I do not wish to extend the competence of the Bill unduly, but it is an opportunity for us to look at the reciprocal health agreements we have with the overseas territories, as mentioned by my hon. Friend the Member for Chichester (Gillian Keegan), and particularly with United Kingdom dependent territories—I am thinking here of the Channel Islands. Under the previous Labour Government, the reciprocal health agreement with Jersey was ripped up and terminated in 2009. Under the coalition agreement in 2011, it was reinstated. However, at present, there is no reciprocal health agreement with Guernsey, which is also responsible for Alderney and Sark. I ask the Minister to consider that during the passage of the Bill.
Stephen Barclay
I am grateful to my hon. Friend for raising that. Understandably, much of the debate today has focused on the EU element of the Bill, but he is quite right to recognise that the reciprocal element extends beyond the EU and particularly to Crown dependencies, overseas territories and countries such as Australia, New Zealand and elsewhere. I am very happy to have those discussions with him.
My opposite number, the hon. Member for Ellesmere Port and Neston, raised a number of points, one of which was the impact on people with long-term conditions. I agree that, without reciprocal healthcare, people with long-term conditions, including those who need dialysis, may find it harder to travel, which is the very essence of why the Bill is necessary, so that we can implement a reciprocal arrangement with the EU or, failing that, with individual member states to support the travel arrangements of those with long-term conditions.
The hon. Gentleman also questioned the £66 million figure that I referenced in my speech, and I am happy to point out that that was in relation to the 2016-17 value of claims made by the UK to EU member states. He also asked about cost recovery more generally and, since 2015, we have increased identified income for the NHS under reciprocal arrangements by 40%, and directly charged income has increased by 86% over the same period. I mentioned the increased focus on that to my hon. Friend the Member for Crawley (Henry Smith), which I hope gives a signal of intent as to the direction of travel on cost recovery.
The hon. Member for Ellesmere Port and Neston also mentioned the role of NHS Improvement, and I am happy to clarify that it is now working with more than 50 NHS trusts to improve their practices further, with a bespoke improvement team in place to provide on-the-ground support and challenge in identifying and sharing best practice.
The hon. Gentleman also mentioned an important point, and one that we will probably go into in more detail in Committee, on data. Again, the policy intent is continuity, rather than a change in our approach to data. Clause 4 expressly contains a safeguard for personal data, which can be processed only where necessary for limited purposes or funding arrangements. That covers, for example, where someone is injured while abroad, where personal data of a medical nature often needs to be shared to allow treatment to take place. At the same time, there are safeguards in the Bill, which I am sure we will explore.
My hon. Friend the Member for North Thanet expressed concern about cherry-picking, and I recognise his point. That is why we are looking for the reciprocal arrangements to continue, although even in the event of no deal and no bilateral deal, local arrangements often apply for healthcare, such as on the basis of long-term residency or previous employment. Those would be local factors, but obviously the policy intent is to have an arrangement with countries across the EU.
The hon. Member for Linlithgow and East Falkirk (Martyn Day) and my hon. Friend the Member for East Renfrewshire (Paul Masterton) spoke about the work of the devolved Assemblies and how we liaise with them. Indeed, I spoke with my Welsh counterpart just yesterday. In the other place, the Parliamentary Under-Secretary of State for Health has been working closely with the devolved Assemblies, as have colleagues and officials in our Department. How we work with the devolved Assemblies is a pertinent point, and we are keen to continue that active dialogue.
My hon. Friend the Member for Poole (Sir Robert Syms) correctly identified the importance of the EHIC card and of inward tourism to the UK. The point about continuity was reinforced by my hon. Friends the Members for Chichester (Gillian Keegan) and for Chelmsford (Vicky Ford) in their thoughtful contributions. It was also echoed by my hon. Friend the Member for Walsall North (Eddie Hughes) when he highlighted the importance of taking a practical approach to how these arrangements apply.
My hon. Friend the Member for Totnes (Dr Wollaston) raised a number of detailed points, and I am happy to have continued dialogue with her on them, although I hope she will draw some comfort from recent quotes and legislative developments in a number of EU27 states. For example, the French Minister for European Affairs said, “France will do as much for British citizens in France as the British authorities do for our citizens.” France has legislation under way. The Spanish Prime Minister said, “I appreciate, and thank very much, Prime Minister May’s commitment to safeguarding those rights. We will do the same with the 300,000 Britons who are in Spain.”
Again, I hope the fact that we actually pay out more to the EU than we currently receive, and the fact that both nations benefit from a reciprocal arrangement, gives an idea of the starting point of the discussions. Like my hon. Friend, I would welcome it if that were done across the EU27 as a whole.
My hon. Friend also raised the issue of dispute resolution, and the current arrangements between the UK and other member states require states to resolve differences, in the first instance, between themselves. That is the existing position that applies, but clearly it would be a matter for negotiation as to how a future UK-EU agreement might be governed. That is a cross-cutting issue; it is not one pertaining solely to this Bill.
It is clearly in the interests of the British public to ensure reciprocal healthcare, arrangements, similar to those currently in place, continue when we leave the EU, whether that happens through an agreement with the EU itself, as we very much want, or through individual arrangements with EU member states.
Mike Amesbury (Weaver Vale) (Lab)
Just for clarification, is the jurisdiction of the European Court of Justice still a red line in the sand?
Stephen Barclay
The issue in terms of the ECJ will be dealt with in other areas of the withdrawal agreement discussions. In the event of a deal, and in the event of no deal, it will be governed by the bilateral arrangements.
I commend this Second Reading to the House, and I look forward to working with colleagues on both sides of the House in Committee.
Question put and agreed to.
Bill accordingly read a Second time.
Healthcare in Essex
Steve Barclay Excerpts(7 years, 7 months ago)
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The Minister for Health (Stephen Barclay)
I congratulate my right hon. Friend the Member for Harlow (Robert Halfon) on securing the debate and on securing an early visit from the Secretary of State. As the whole House knows, he is passionate about the future of the Princess Alexandra Hospital in Harlow and he has raised this issue assiduously in a number of debates and interventions in the House. As he referred to, we had a very productive meeting with the hospital chief executive in June, when we discussed a range of issues, including the workforce and services offered at the hospital. That is in addition to an earlier Adjournment debate, as well as an Adjournment debate with my predecessor a year ago and exchanges at Health questions. On behalf of his constituents, he has brought these issues to the attention of the House extremely effectively.
I also place on record that I very much recognise that these issues are extremely important to Epping Forest as well, Madam Deputy Speaker. I know how assiduously you have campaigned on behalf of your constituents. Indeed, this is an issue that Members across Essex and Hertfordshire have spoken up on. That was reflected in previous debates and was reflected in the contribution from my hon. Friend the Member for Chelmsford (Vicky Ford). As we all recall, she was instrumental, as were other Essex MPs, including my right hon. Friend, in securing the new medical school, which, as she said, will help us to deliver the extra doctors to go with the buildings and capital spend, which we are discussing today.
As my right hon. Friend is aware, but for the benefit of the House, we have the sustainability and transformation fund as part of the Government’s commitment to upgrading the NHS estate. This investment will modernise and transform the NHS’s buildings and services, with the money going towards a range of programmes. This is part of the Government’s commitment to spending £3.9 billion on capital investment in buildings and facilities by 2022-23 and alongside the £20.5 billion a year extra that my right hon. Friend referred to. This investment—the biggest ever in the NHS—reflects the fact that the NHS is the public’s No. 1 priority, as indeed it is the Government’s No. 1 priority, and is an indication of the Prime Minister’s personal commitment to funding the NHS and ensuring it is fit for the future.
My right hon. Friend will be aware that the application window has now closed. I know that considerable work was done following the earlier application when a bid of between £500 million and £600 million was submitted. I am sure he will recognise that this was a significant sum but that the further work has brought it closer to the £330 million, and officials in NHS England and NHS Improvement are working closely with the Department to evaluate that bid alongside the other bids. As I mentioned in the previous debate, all bids will be assessed against standard criteria, including their value for money and contribution to transforming services and managing demand sustainably, as well as demonstrating their fit within a wider STP level estate strategy.
My right hon. Friend asked about timescales. The timescales are as previously referred to, with the commitment to decisions being made in the autumn. That position has not changed.
It is worth remembering that STP funding is only one element of support available to trusts. In 2017-18, the trust was successful in securing £2 million of emergency department capital funding to support the redesign of the emergency department. This funding was targeted to improve facilities and support improvements, including investment in paediatrics and the emergency department. In this financial year, capital funding to support winter pressures is also available to the trust, and this funding is part of the £145 million given to 80 NHS trusts across the country ahead of winter to improve emergency care. I understand that this money is earmarked for increasing bed capacity.
As we discussed in the summer, the trust recently exited special measures, with two thirds of services moving to a good or outstanding rating. This is a big achievement, and I know that the focus for 2018-19 is to achieve a good rating from the Care Quality Commission. My right hon. Friend has spoken about this in previous debates, and I join him once again in paying tribute to the staff who worked so hard to take the trust out of special measures.
It is clear that the hospital is a vital element of the local economy. I know that the Princess Alexandra Hospital NHS Trust has been working hard to improve recruitment and retention, and I am pleased that this is still a focus for it. The hospital is one of Health Education England’s nursing associate pilot sites through its lead partner, Hertfordshire Partnership University NHS Foundation Trust, and I am aware of plans for a huge expansion in the numbers of nursing associates through the apprentice route, which will positively impact on the work of the trust.
As I am sure the House is well aware, my right hon. Friend, like me, is a keen supporter of apprenticeships. I know that the hospital has taken on apprentices in the last year but that the number of apprentices is well below the target. It should be noted that any nursing associates in training as part of the scheme I just mentioned will not be included in the apprentice figures. As of April 2018, we know of 18 apprentices starting at the hospital, against a target of 76. I am keen to work with my right hon. Friend to continue the work that he has done in the House to ensure that the hospital meets that apprenticeship target. Both he and I are strongly committed to bringing more apprentices into the workforce.
My right hon. Friend referred to the Harlow science hub campus programme. Partly as a result of his campaigning, there will be a new public health campus in Harlow, at a cost of about £400 million. Not only are the Government making a significant contribution to the NHS, but the fact that the project is still on schedule—and by 2024, following a phased opening from 2021, approximately 2,700 staff will be based there—is a significant tribute to the work that my right hon. Friend has done, along with others, in securing a much-sought-after commitment to Harlow. I know that Public Health England and the Princess Alexandra Hospital have been discussing the opportunities that will arise as a result of the move to Harlow, and I hope to hear more about that soon.
I commend the work that my right hon. Friend is doing to raise support for the STP bid by the Princess Alexandra Hospital Trust. He has raised the estate issues faced by the trust on more than one occasion in the House, and in meetings with the Secretary of State and me, and I know that he raised them with my predecessor as well. We recognise that the hospital estate is in poor condition, which is why I am pleased that the trust has submitted the revised STP bid. I am also pleased that money was made available last year, and will be made available again this year, to make improvements to the hospital in the interim.
I look forward to continuing to work on this issue with my right hon. Friend, and to working on the future of the NHS in Harlow as well as the surrounding region. As has been made clear again this evening, Madam Deputy Speaker—alongside your own work—the patients and staff of the hospital can be confident that they could have no better champion than my right hon. Friend, who has campaigned to secure this much-needed investment.
Madam Deputy Speaker (Dame Eleanor Laing)
What an excellent, meaningful, well-targeted debate.
Question put and agreed to.
Future Reciprocal Healthcare Arrangements
Steve Barclay Excerpts(7 years, 7 months ago)
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The Minister for Health (Stephen Barclay)
Today, the Government are introducing the Healthcare (International Arrangements) Bill. This will provide the Government with the powers that are needed to fund and effectively implement arrangements for UK nationals to obtain healthcare abroad after the UK exits the European Union (EU).
Current EU reciprocal healthcare arrangements enable UK nationals to access healthcare when they live, study, work, or travel abroad and visa-versa for EU citizens when in the UK. They give people more life options, and support tourism, businesses, and healthcare co-operation. The UK also has a number of reciprocal healthcare agreements with non-EU and European Economic Area countries, such as Australia and New Zealand.
These arrangements ensure that UK nationals living and working in the EU, EEA and Switzerland can access healthcare in exchange for paying taxes and social security contributions. The UK also funds healthcare abroad for a number of current or former UK residents. This includes healthcare for UK state pensioners who spend their retirement in the EU and needs arising when UK residents visit the EU for holiday or study through the European healthcare insurance card (EHIC) Scheme.
The Bill is part of the Government’s preparations for EU exit and will ensure that whatever the outcome of EU exit, the Government can take the necessary steps to continue reciprocal healthcare arrangements or otherwise support UK residents to obtain healthcare when they move to or visit the EU.
Presently, the Secretary of State for Health and Social Care has limited domestic powers to fund and arrange healthcare outside the UK. When the UK leaves the EU the current EU regulations will no longer be part of UK law and new legislation will be needed.
This Bill confers powers on the Secretary of State to make and arrange for payments to be made in respect of the cost of healthcare provided outside the UK. This would allow for the funding of reciprocal healthcare arrangements for UK nationals living in the EU, EEA and Switzerland.
The Bill also confers powers on the Secretary of State to make regulations for and in connection with the provision of healthcare abroad and to give effect to healthcare agreements with other countries or territories (both EU and non-EU) or supranational bodies such as the EU.
Finally, the Bill provides for the lawful processing of data where necessary for purposes of implementing, operating or facilitating the operation of reciprocal healthcare arrangements or payments.
Current healthcare agreements benefit people in all parts of the UK, assisting people to obtain healthcare when they are abroad. The UK Government are therefore engaging with the devolved Administrations to deliver an approach that works for the whole UK in a way that fully respects the devolution settlements.
The Bill underscores the Government’s commitment to reaching a reciprocal healthcare agreement with the EU, or where necessary making agreements with member states, and to exploring potential agreements with third countries in the future.
The Government welcome the forthcoming scrutiny of the Bill, to ensure that it achieves its aims for the continuation of healthcare support for UK nationals in the EU, EEA and Switzerland after the UK exits the EU, but also enabling the UK to look to the future.
[HCWS1040]
Oral Answers to Questions
Steve Barclay Excerpts(7 years, 7 months ago)
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Alan Mak (Havant) (Con)
The Minister for Health (Stephen Barclay)
Having committed an additional £20 billion in real terms, the Government are asking the NHS to deliver a long-term plan that includes continued improvements in productivity and efficiency, and we are reinvesting the savings in improved patient care.
Damien Moore
I congratulate my hon. Friend on his drive to recycle more hospital equipment such as zimmer frames, crutches and wheelchairs, but what steps is his Department taking to encourage more hospitals such as Southport Hospital in my constituency to run recycling programmes to reduce waste in our NHS?
Stephen Barclay
I am keen to work with my hon. Friend to encourage Southport and other trusts to recycle equipment. I know from my family’s experience that it causes significant frustration when people see hospitals not collecting perfectly good medical equipment that could be recycled. I am keen to work with him and with trusts to ensure that we learn from that.
Stephen Barclay
I commend my hon. Friend for his excellent report for the Centre for Policy Studies, which highlights the opportunities provided by technology. I was at a Scan4Safety event last night, looking at how barcodes are being used at six trusts, and at how that could be expanded to deliver 4:1 efficiency savings and improve patient care through the safety it offers.
Laura Smith (Crewe and Nantwich) (Lab)
Does the Minister believe that the practice of cutting funding to hospitals that miss A&E targets helps to improve the patient experience at those hospitals? Will he agree to meet me to discuss how this issue has affected Leighton hospital, which serves my constituents?
Stephen Barclay
The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.
Mr David Lammy (Tottenham) (Lab)
Jack Adcock’s death was a tragedy, but why did the General Medical Council spend £30,000 on getting Dr Hadiza Bawa-Garba struck off, even though she had already faced the consequences of her mistakes in court? Does the Minister think that the GMC needs to sort its act out and that Charlie Massey should resign?
Stephen Barclay
As the right hon. Gentleman will be aware, Professor Norman Williams looked at the circumstances of this case and produced a report on it for the Government. As a part of that, we are looking at a number of factors.
David Tredinnick (Bosworth) (Con)
Is the Minister aware that in terms of value for money and efficiency, the Government of India’s integrated health Ministry has half a million ayurvedic doctors and a quarter of a million homeopathic doctors? At a clinic I visited recently in Karnataka province, four fifths of the patients who would have normally gone to see a western doctor were treated by those local doctors. Will he build links with the Indian Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy?
Stephen Barclay
I pay tribute to my hon. Friend for the longevity and sincerity of his campaigning on these issues. He draws attention to the wider point of how patients presenting with multiple and complex conditions need to be treated in multiple ways, and what he refers to is a part of that wider discussion.
Dr Philippa Whitford (Central Ayrshire) (SNP)
NHS England is being ripped off to the tune of £230 million a year as the price of some off-patent drugs and non-standard preparations, or specials, have been hiked up hundreds of times, for example to over £1,000 for a bottle of pain-relieving mouthwash. In Scotland, specials remain in-house to keep the price down, but a year and a half on from the Health Service Medical Supplies (Costs) Act 2017, why have the Government not used its powers to stop this drug racketeering?
Stephen Barclay
The hon. Lady, very astutely and correctly, identifies the issue, which is how we ensure value for money from specials. Indeed, I commend The Times for highlighting a number of these issues. We are looking at this area. As we commit an extra £20 billion in funding to the NHS, our commitment is to ensure that we derive value for money from that investment. That applies to specials, too.
Dr Whitford
The healthcare market in NHS England is estimated to cost £5 billion to £10 billion a year and involves 2.5 million nursing hours a week being wasted on non-clinical paperwork. Does the Minister not recognise that this is the biggest inefficiency? Will he commit to reversing the disastrous marketisation of NHS England?
Stephen Barclay
Again, the hon. Lady draws attention to my work on driving productivity improvements within the system, which looks at a range of efficiencies such as sending texts and emails, dealing with missed appointments and the use of green energy. We can implement a whole range of initiatives as a part of that agenda.
Steve Double (St Austell and Newquay) (Con)
As the first port of call for patients with often minor ailments, community pharmacists can really help to improve the efficiency of the NHS by taking pressure off GPs. What plans do the Government have to support and enhance the role of community pharmacists?
Stephen Barclay
My hon. Friend is right to draw attention to the valuable role played by pharmacies. This is part of a wider education campaign within the NHS and increased access to clinicians, such as through 111, is another component of that. We want to ensure that rather than people’s first port of call being a GP, they access the NHS and pharmacies at the appropriate time.
Justin Madders (Ellesmere Port and Neston) (Lab)
At the end of the last financial year, trusts owed the Department a staggering £11 billion. NHS providers say that this is locking some trusts into
“a vicious circle of inevitable failure”,
and the King’s Fund says that there is no prospect of them ever repaying. Trusts with the biggest debts are forced to pay the highest levels of interest. How can the Minister expect trusts to be efficient when they are paying an interest rate of 6% on debts to his Department?
Stephen Barclay
As it happens, I will be at an event with NHS providers—chief execs—this evening, when I am sure that this will be one of a number of issues that we will discuss. The hon. Gentleman is right to draw attention to the very high private finance initiative costs that many trusts face due to contracts signed under the previous Labour Government. That is a real pressure faced by many trusts.
Richard Benyon (Newbury) (Con)
The Minister for Health (Stephen Barclay)
The planned temporary overnight closure of the Princess Royal Hospital’s A&E in Telford is necessary to ensure that patients continue to receive safe care. The Shrewsbury and Telford Hospital NHS Trust is working closely with colleagues in neighbouring provider trusts and the ambulance service to develop plans for key clinical pathways to minimise the impact.
Emma Reynolds
The proposed closure of Telford A&E would pile even more pressure on New Cross Hospital in my constituency. If the Government will not step in to stop the closure, as it sounds is the case from the Minister’s answer, will they give New Cross the resources it needs to recruit upfront the nurses, doctors and other staff they need so that patients do not have to suffer longer delays?
Stephen Barclay
The current modelling suggests that about 11 ambulances will be diverted from the Shrewsbury and Telford Hospital NHS Trust between the hours of 10 pm and 8 am during closure. Of the patients who go to Wolverhampton, any admitted as in-patients will return to Shrewsbury and Telford and any who are discharged will be discharged from Wolverhampton.
Lucy Allan (Telford) (Con)
The chief executive of Royal Wolverhampton NHS Trust says that the closure at Telford is the result of bad planning and could have been prevented. Does the Minister agree it is wholly unacceptable that my constituents’ safety should be put at risk by a preventable closure that is the result of bad planning by management, and will he do all he can to ensure that the hospital management have the help they need to properly run our hospital and properly plan for the needs of our community?
Stephen Barclay
First, may I pay tribute to my hon. Friend, who has campaigned assiduously on behalf of her constituents? She has lobbied me and the Secretary of State and made her case very powerfully to NHS leaders. There has been progress: three additional consultants have been hired and attempts made to recruit middle-ranking doctors to the trust, including from neighbouring trusts. We are making a significant capital investment in the Shrewsbury and Telford Hospital NHS Trust, and these changes must be seen in the light of that.
Sir Edward Leigh (Gainsborough) (Con)
The Minister for Health (Stephen Barclay)
My hon. Friend is right to highlight this. The Secretary of State was at the trust last week, and I visited earlier in the year. There is a specific range of actions, including partnership with Sherwood Forest Hospitals NHS Foundation Trust; advanced clinical practitioner courses, which started in June; £1.8 million of capital to support improvements to patient flow; and a frailty pilot at Lincoln. There is an intensive programme of work with this trust, because we recognise my hon. Friend’s concerns.
Liz McInnes (Heywood and Middleton) (Lab)
Stephen Barclay
As the hon. Lady will know, since 2010, the number of paramedics has increased by more than 30% and the pay band has been increased from band 5 to band 6. She will also know from the excellent work of Lord Carter that there was significant variation between ambulance services and a significant opportunity to make savings that can be reinvested in ambulances by addressing differences in sickness rates, “hear and treat” and “see and treat” rates and other variables. We have also committed additional funding for new ambulances, including in the north-west, which will be in place by this winter.
Boris Johnson (Uxbridge and South Ruislip) (Con)
Mike Amesbury (Weaver Vale) (Lab)
Stephen Barclay
I am not aware of the specific details of that, but I am happy to meet the hon. Gentleman to discuss it if he has particular concerns he wishes to raise.
Mr Marcus Fysh (Yeovil) (Con)
Toby Perkins (Chesterfield) (Lab)
The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?
Stephen Barclay
The hon. Gentleman is right to say that we need to improve those handovers. We have improvement programmes in place at 11 hospital sites in the east midlands, alongside which we are making a £4.9 million investment in 37 new ambulances. Part of this is also about the length of stay and addressing the pathway.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
The Mid Yorkshire Hospitals Trust is proposing to close our midwife-led maternity unit, telling me that, while it is safe, unless it has 500 births a year, it is not value for money. Is that a new national standard for midwife maternity units, because if so it would close 90% of free-standing units? Will a Minister meet me on this matter, because it is unfair on local parents, and, frankly, we are sick and tired of losing services from our towns?
Stephen Barclay
I am happy to meet the right hon. Lady and to discuss the matter further.
Tom Pursglove (Corby) (Con)
I am extremely concerned about the case of Logan, a young boy in my constituency who requires round-the-clock care and the handling of his case by Corby clinical commissioning group. I have written to the Minister raising concerns about this case, but is he willing to meet me and Logan’s parents, Darren and Wendy, to talk about how this could perhaps be resolved and to apply any pressure that he can, because, as a family, they should be making memories at the moment, not battling local NHS bureaucracy?
Stephanie Peacock (Barnsley East) (Lab)
Will the Government write off the debts of Yorkshire hospitals so that extra money invested can go into patient care?
Stephen Barclay
As the Secretary of State set out, we are making a significant funding commitment to the NHS—the extra £20 billion—but that is not conditional on writing off debt.
Robert Courts (Witney) (Con)
Will the Minister please provide an update to the House on work to ensure that we train more GPs for England, particularly for west Oxfordshire?
Rachel Maclean (Redditch) (Con)
I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?
Stephen Barclay
As my hon. Friend says, there is significant capital investment into Worcestershire, as well as a major programme of improvements addressing variation in ambulances, but of course I am also happy to meet her to discuss the matter.
Daniel Zeichner (Cambridge) (Lab)
Last week, the chief executive of the Association of the British Pharmaceutical Industry warned that even associate membership of the European Medicines Agency would not do for our life sciences sector, so can the Secretary of State tell us how much longer we will have to wait and how much more we will have to pay for new medicines if we are outside the European medicines market?
Clinical Waste Incineration
Steve Barclay Excerpts(7 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care to update the House on clinical waste incineration across the NHS.
The Minister for Health (Stephen Barclay)
Yesterday evening, the hon. Gentleman, in a point of order, repeated claims made by Healthcare Environmental Services regarding incineration capacity, and the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) raised a point of order on the capability of Mitie to deliver waste management services for the NHS and on TUPE arrangements for staff employed by Healthcare Environmental Services. I would like to clarify why the statement that there is sufficient incinerator capacity is correct, and why the claims made by the company, which is currently subject to criminal investigation, should not be taken at face value, as appears to have been the case yesterday.
With regard to incinerator capacity, there have been quotes from Environment Agency and NHS Improvement officials, cited in the Health Service Journal in May and August 2018, suggesting that there is a shortage of clinical waste incinerator capacity. By the time of my statement on 9 October, far more due diligence had been conducted on the claims made by Healthcare Environmental Services. Analysis carried out by NHSI identified 2,269 tonnes of incinerator capacity in October. The trusts served by Healthcare Environmental Services produced 595 tonnes. The analysis shows that there is sufficient incinerator capacity for clinical waste and that the statement made to the House was therefore correct. The issue is whether HES is willing to pay for that capacity. The fact that Mitie has secured 1,000 tonnes of incinerator capacity demonstrates that it is available.
The right hon. Member for Normanton, Pontefract and Castleford questioned whether Mitie was capable of delivering waste management for the NHS. The Mitie contract was put in place rapidly on 5 October to ensure continuity of service following trusts exercising their step-in and then termination rights to end their contracts with Healthcare Environmental Services. Over that weekend, Mitie visited the NHS sites to understand their business needs and the frequency of collections required, and responded immediately to trusts where waste needed to be collected. It also located bins on those sites so that the collections could start. Putting a new contract in place so quickly clearly means that there needs to be a phased approach to Mitie providing 100% of the service previously provided by Healthcare Environmental Services.
Mitie is working closely with NHSI to ensure that the needs of the trusts are being met, and regular collection schedules are in place at sufficient levels to maintain all patient services safely. The trusts also have additional contingency storage in place on site, with the waste being collected correctly stored so that the NHS can contain its services. This storage contingency will remain in place until Mitie meets 100% of the waste collection frequency required by the trusts. There is no risk to public safety through the action taken by the trusts.
As regards TUPE, Mitie has written to Healthcare Environmental Services and its legal representatives to request complete information, to assess the situation with regard to the potential transferring of employees and to minimise disruption for those employees. Mitie has also set up a dedicated helpline and email address to support Healthcare Environmental Services staff at this uncertain time.
It continues to be the case that there is no risk to public safety through the action taken by these trusts and that all NHS trusts have been able to continue to provide operations in line with meeting our key objective.
Jonathan Ashworth
All we are asking for from the Minister is full transparency. Last week, he told the House with great confidence that
“the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid.”—[Official Report, 9 October 2018; Vol. 647, c. 39.]
Subsequently, we read in the Health Service Journal, as he mentioned, that NHS Improvement had concerns about capacity back in August and acknowledged that there were “national market capacity issues”. He has told us today that due diligence has been done since then. Why did he decide not to reveal in his statement last week that concerns were raised with him back in August? Was he aware when he came to the House and made his statement that these concerns had been raised in August? He tells us that extra due diligence has been carried out. Can he explain what that extra due diligence actually is?
The Minister has tried to reassure us again today that there are no public health implications to the measures that have been put in place since HES lost these contracts. Can he therefore explain his view of the various allegations currently circulating on social media, with photos and videos suggesting that waste is not being picked up from a health centre in Keighley, that hospital staff in Leeds are shifting waste in inappropriate overalls, that hazardous waste at Dewsbury is being stored in inappropriate shipping containers and that up to 15 trusts across Yorkshire are storing waste illegally? Has he checked each and every one of those allegations? Can he tell us what his inquiries have revealed about them? If he has not looked into each and every one of those allegations, why not?
Can the Minister assure us that incineration sites to which tonnes of waste from HES facilities are now taken are big enough to safely manage this waste, that the drivers transporting the waste are suitably qualified and that the incinerators now being used are designed to deal with hazardous waste? Last week, I asked him to give us a cast-iron guarantee that there is no risk to public health at any of those sites, or where the waste is currently being incinerated. Will he give us that absolute guarantee today? All we want from the Minister is complete and utter transparency. We have not had that so far.
Stephen Barclay
The hon. Gentleman seems to be spending a lot of time on social media and not looking at the data on what is being done. There was a time when Opposition Members were used to the complexity of legal agreements and contracts and would have understood that mobilising 17 NHS contracts and maintaining NHS operations on those sites requires a significant amount of work. It takes time for Mitie to mobilise that contract—[Interruption.] If he gives me a moment, I will address directly the different concerns that he raised.
The hon. Gentleman’s first concern was that a statement given in October, with up-to-date information based on the work done leading up to it, was in some way incorrect because it did not pick up on early discussions within NHSI, which was only notified on 31 July. Obviously the concerns raised by HES about a lack of incinerators needed to be looked into. Having been looked into, those concerns were found not to have merit. The evidence for that is the fact that the new supplier, Mitie, has been able to secure 1,000 tonnes of incinerator capacity. If the hon. Gentleman’s central charge is correct, he will need to explain how Mitie has been able to find available incineration capacity when HES was unable to do so.
The hon. Gentleman asked when I was notified. I was not notified of the internal discussions among officials in August; I was not dealing with the issue at that point. The issue is what the House was informed of when the statement was made.
On the allegations on social media, I have not checked every single tweet that the hon. Gentleman has looked at, but the fact is that of the 17 trusts, three have had the stock of waste on their sites cleared and 12 are due to have theirs cleared by the end of the week, with two remaining, as Mitie mobilises from around 80% of service delivery now to 100% in the coming weeks.
The right hon. Member for Normanton, Pontefract and Castleford has made some legitimate points about TUPE and about Mitie scaling up, which I am sure she will come on to. Those points were not addressed, surprisingly, in the shadow Secretary of State’s comments, but I am happy to pick them up in due course. One of the advantages of Mitie is that it should deliver greater resilience, because it is not looking to deliver all the elements of the contract in the way that HES is. It is bringing in other firms, such as logistics suppliers and disposal firms, so there will be greater resilience in the contract, but we can address any specific concerns that the right hon. Lady has, given her constituency interest.
Rebecca Pow (Taunton Deane) (Con)
I thank the Minister for his clear words. I remember just how emotive the whole issue of incineration can be, because I was a news reporter at the time of the foot and mouth and BSE sagas, and it is something that worries the public. Can I have an assurance from the Minister that there is an industry-wide agreement that there is enough capacity everywhere to deal with incineration?
Stephen Barclay
My hon. Friend is right to identify the concern there has been following comments on social media and certain media reports about incineration and the nature of this clinical waste. As I said in my statement, I am happy to confirm that there is sufficient capacity, as Mitie has demonstrated. It is worth reminding the House that just 1.1% of the waste under discussion is anatomical, and many of the media reports do not reflect that.
Neil Gray (Airdrie and Shotts) (SNP)
The business concerned, Healthcare Environmental, is based in Shotts in my constituency. Waste incineration—where and how it happens—is always an emotive and controversial issue, and it is imperative that we get strong regulation right. But it appears that the UK Government have influenced—shall we say?—that regulation to deal with an issue that the company claims was contained and it had a plan to deal with.
Can the Minister confirm whether special dispensation has been granted to a municipal site in Slough that apparently does not have a licence to deal with hazardous waste, to incinerate this waste in a way that would otherwise have been inappropriate? Can he confirm that the waste has been handled by unlicensed individuals and been moved against normal regulations? Can he clarify what role the Cabinet Office has had in this issue and whether the UK Government have had any relationship with Healthcare Environmental’s competitor, Stericycle? The focus last week was on Healthcare Environmental, and now the focus appears to turn to Government actions. With 400 jobs under threat across the UK and 150 in my constituency, is it not time we had an independent inquiry into this whole mess?
Stephen Barclay
The hon. Gentleman is right to recognise that there is a significant impact in Scotland, given the services that HES supplies, and it is worth reminding the House that HES is still trading and clearing waste from a number of NHS sites. However, given that it has been subject to a series of actions by the Environment Agency and is subject to a criminal investigation, it is worth treating HES’s claims with a degree of caution.
The Environment Agency is of course an independent agency, so it is for the Environment Agency to look at how waste is being processed, and a strict legal framework applies to that. The specific concern about Slough has not been raised with me, but I am happy to take that away and write to the hon. Gentleman.
The Cabinet Office has been in active discussion with the NHS and the Department of Health and Social Care, as have Scottish officials, who have worked very constructively with officials in England. This has been seen as an issue that affects Scotland as well as England, and it is one on which officials have worked collaboratively.
Mrs Anne Main (St Albans) (Con)
Can my hon. Friend reassure patients who might be concerned that their operations have been delayed in any way, shape or form by this whole fiasco that at no point were any members of the public put at risk by the treatment or non-treatment of this particular sort of clinical waste?
Stephen Barclay
My hon. Friend is absolutely right to focus on that. The key risk in respect of this supplier was that the NHS’s ability to continue to perform operations would be affected if it could not clear its clinical waste. I am happy to reassure her that all 17 trusts affected have been able to maintain their services, which ultimately is the key issue for patients and our constituents.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
Can the Minister confirm that the staff are being offered TUPE transfers? I have heard from constituents who have been told that they are not, and clearly it is completely unfair for staff to be stuck in limbo like this. Can he say whether he has considered breaking up the contract and treating incineration separately, what the additional cost of the new contract might be and which part of the NHS is paying?
Stephen Barclay
The right hon. Lady raises an important point. I am happy to meet her to discuss these issues, given her constituency interest. I understand that she met members of staff on Friday. I very much urge HES employees who are listening to the debate to phone Mitie’s dedicated helpline and provide their details. The key issue is that Mitie has requested information from HES that it has not provided. To assess whether TUPE legally applies and the work patterns and issues of the staff involved, Mitie relies on HES providing information that, to date, has not been provided. The key issues in giving reassurance to staff are for them to contact the helpline and for HES to provide the information requested.
Julian Knight (Solihull) (Con)
I congratulate the Minister on the measured way in which he is dealing with this unpleasant situation. Can he confirm that the Environment Agency will suspend HES’s remaining permits if enforcement action does not return it to full compliance?
Stephen Barclay
My hon. Friend will be aware that the Environment Agency is an independent body, so it will be for the Environment Agency to reach a decision on whether such a suspension should be raised. I can reassure the House that the issue is subject to great scrutiny at present and that the Environment Agency is looking at it very closely.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
It seems to me that there are two ways of looking at such issues. Factoring in numbers, statistics and logic is one way and leads to one conclusion, but when we think about human decency and human dignity it becomes something entirely different. The public’s confidence in the methodology is absolutely paramount at this stage. First, does the Minister recognise that, and secondly, can he tell me what he is doing to restore that public confidence?
Stephen Barclay
The hon. Gentleman is absolutely right, and I very much recognise that. The emotive nature of the topic and the way in which some of the headlines have been written do cause alarm. We are being very strategic. First, we are ensuring that our key priority, which is continuity of service in hospitals, is maintained. Secondly, we are ensuring that a supplier is mobilised as quickly as possible. He will recognise that to mobilise a supplier over so many contracts, where those contracts are not uniform—there are different legal provisions in them—is a complex issue. Thirdly, where there is an interregnum with regard to contingencies and waste that needs to be stored on site, we are ensuring that that is done in the safest way possible and that the waste is then cleared at the earliest opportunity.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my hon. Friend for the reassurance that there is enough capacity in the incineration system to deal with this issue, but will he confirm that the delays caused by Healthcare Environmental Services have not had an impact on the capacity for patients to receive the treatment that they need?
Stephen Barclay
My hon. Friend is absolutely right that the issues we have experienced with the supplier have not affected the NHS’s ability to maintain its service. That has been our key objective throughout, and that continues to be the case.
John Howell (Henley) (Con)
Will the Minister confirm that, after the NHS trusts had terminated their contracts with HES, a new contract was given almost immediately?
Stephen Barclay
My hon. Friend is absolutely right. One of the key issues was to have alternative provision in place as quickly as possible so that we were not in the situation of waste being stored on site beyond the absolute minimum. It is a tribute to officials in the Department and in the NHS, the Department for Environment, Food and Rural Affairs and elsewhere that a quite complex set of legal arrangements has been mobilised in such a short period to ensure that services are maintained.
Mr Marcus Jones (Nuneaton) (Con)
While the backlog is being cleared, will my hon. Friend confirm that any waste will be kept in a secure and safe fashion? Will he also be more exact about when he thinks the backlog of waste currently in the system will be cleared?
Stephen Barclay
There are two different components to that. There is the waste on sites, such as at Normanton, where HES has allowed a degree of waste to be stored, but I think my hon. Friend’s question is driving at the waste on hospital sites. As I said in my statement—[Interruption.] If the hon. Member for Leicester South (Jonathan Ashworth) waits for the reply, he will hear that the stock on those sites is being cleared. Perhaps he has been busy checking social media again. The bulk of the sites will be cleared by the end of the week; there will be two remaining beyond this week. We are very much focusing on that issue.
Mr Philip Hollobone (Kettering) (Con)
Will the Minister confirm that, had he not taken action, the failure of Healthcare Environmental Services to dispose of the clinical waste properly would have presented a serious risk of clinical waste backing up in hospitals and other healthcare facilities? Owing to his taking effective action in a timely way, that has been avoided and healthcare delivery has not been interrupted.
Stephen Barclay
I thank my hon. Friend for that question. There has very much been a Government-wide effort to ensure that waste did not build up, for the reason he mentions—the ability of the NHS to maintain its services and continue to operate if clinical waste could not be removed from the site. There is a varying degree of contingency capacity on different sites, so certain hospital sites would quite quickly exhaust that capacity if it was not cleared. That is why, as my hon. Friend the Member for Henley (John Howell) said, the ability to mobilise the contract quickly was so important.
Eddie Hughes (Walsall North) (Con)
Will the Minister assure the House that good governance will be in place to ensure that the new provider can dispose of the waste very safely?
Stephen Barclay
I am very happy to give my hon. Friend that assurance. There are lessons to be learned from the HES contract, and I am keen that we do so, but as I commented earlier, the contract with Mitie—through the use of different logistics firms and different waste sites—will actually build greater resilience into the arrangements for clearing clinical waste.
Tom Pursglove (Corby) (Con)
Building on that point, will my hon. Friend ensure that there is an overarching review of local processes to make sure that failings of this sort by a contractor cannot happen again anywhere in the country?
Stephen Barclay
I am very happy to give my hon. Friend that reassurance. It is important, where a supplier has got into such difficulties, that we learn the lessons and ensure that they are part of contract procurement moving forward.
Dangerous Waste and Body Parts Disposal: NHS
Steve Barclay Excerpts(7 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the accumulation of hundreds of tonnes of dangerous waste.
The Minister for Health (Stephen Barclay)
As I set out in the written statement published this morning, on 31 July the Environment Agency notified central Government of an issue concerning clinical waste disposal. The primary concern was that too much waste was being held by a contractor, Healthcare Environment Services, in a number of waste storage and treatment sites. This included waste collected from hospitals and other public services. Although the waste was stored securely, it was not being disposed of within the correct regulatory timescales.
The Department of Health and Social Care, the NHS, the Department for Environment, Food and Rural Affairs, the Environment Agency and the Cabinet Office have worked together to resolve the issues. Our priority throughout has been to ensure that proper measures were put in place to enable trusts to continue to operate as normal. A major part of the contingency plans concerned commercially sensitive contractual discussions with HES and other providers.
Following the Environment Agency’s partial suspension of HES’s Normanton site, which came into force on 3 October 2018, NHS Improvement wrote to HES to raise its concerns. NHSI gave HES an opportunity to set out how it was complying with its legal and contractual obligations; HES failed to provide that assurance. As a result, 15 NHS trusts served contract termination notices on Sunday 7 October. As part of our contingency arrangements, we ran a tender process with the clinical waste sector before awarding a new contract to Mitie. As contracts with HES were terminated over the weekend, Mitie stepped in and, from Monday morning, provided continuing waste collection and incineration across all of these organisations.
In September, officials from the Department of Health and Social Care visited each of the major trauma centres affected and confirmed that waste was being stored correctly and that contingency plans were in place.
In addition, visits have been undertaken to each of the sites by the Environment Agency this weekend and this week, alongside earlier visits. The Environment Agency is continuing its enforcement action against HES. This includes ensuring that excess waste is cleared from non-compliant sites. The Government are working with the Environment Agency and the NHS to ensure that lessons are learned, and we are reviewing how contracts will be awarded in the future. I have updated the House on this situation today as new contracts were implemented on Sunday following the conclusion of this commercially sensitive process. Our priority throughout has been to ensure that measures were put in place so that the NHS could continue operating as normal. No gap in service provision has been reported and we are working to ensure that that remains the case.
Jonathan Ashworth
This is an absolutely horrific scandal. A private contractor has failed in its responsibilities to a quite staggering degree. Three hundred and fifty tonnes of waste, including human body parts, amputated limbs, infectious fluid and substances of cancer, was left effectively stockpiled and not safely disposed of; it is an absolute scandal. How on earth did we get to this? If the Environment Agency first raised concerns in March, if Ministers were formally informed in July, and if Cobra was convened and chaired by the Health Secretary last month—by the way, I really think that the Health Secretary should be answering questions at the Dispatch Box today—why was the decision taken not to inform Parliament and the public sooner? Given that concerns were raised in March, why did the NHS not intervene earlier? In fact, concerns were raised with NHS England last year, so can the Minister tell us what monitoring, if any, of the HES contract was put in place by the Department and Ministers?
The Minister referred to 15 trusts having terminated their contracts. The Health Service Journal reported that up to 50 trusts were affected. Will he clarify what the status is of the contracts with the remaining 35 trusts? Where Mitie has taken over the contracts, what regulation and oversight of Mitie and its subcontractors is now in place? Is he confident that there are enough incinerators across the country to dispose of waste in a timely manner?
Let me turn now to the public health implications. At the Normanton site, we were told that waste is now in refrigerators, but where was it before if not in refrigerators? Hospitals are now using temporary containers, but questions have been raised about the public safety implications of those containers. Can the Minister give us an absolute guarantee that those containers are safe and that there is no public health risk?
We are picking up the pieces, yet again, of another disastrous procurement of an outsourced contract by a private firm going wrong. What plans are now in place to ensure that something like this never happens again?
Stephen Barclay
Let me pick up on the various points that the hon. Gentleman has raised. On when Parliament was told, as I said in my statement, the partial suspension notice was served on the company on 3 October and new contracts were put in place over the weekend. This is, therefore, the first opportunity, following what had been commercially sensitive negotiations, to notify the House. It is also right to remind Members that the key strategic objective throughout has been to maintain operations at NHS hospitals to ensure that clinical waste is being collected. That strategic objective has been maintained at all times.
The hon. Gentleman asked a number of other questions, including whether there is enough incinerator capacity in the system. The answer to that is, yes there is. There are 24 incinerators. The Department for Environment, Food and Rural Affairs estimates that there is more than 30,000 tonnes of spare capacity in the system, and that there is significant capacity over and above that required by HES to perform its contract, so I can be very clear to the House that, moving forward, there is sufficient incinerator capacity.
The hon. Gentleman used some inflammatory language. It is worth reminding the House that just 1.1% of this clinical waste is anatomical, so some of the media headlines are slightly out of step with reality. The partial suspension that has been served on Normanton is solely in respect of the incinerator; it does not apply to the other sites under HES contractual arrangements with the trust.
The hon. Gentleman asked whether the waste was being secured safely. The answer is yes; the Environment Agency has been inspecting the situation. The issue is the overstorage of waste, not that the waste is not being stored in a safe manner. [Interruption.] Well, that is the legal remit of the Environment Agency, which is an independent body. It is right that the law is applied; the hon. Gentleman may not like to apply the law, but this is the legal process. Officials from the Department of Health have been to the major trauma sites to see the contingency plans at first hand, and the storage and capacity is in place at those sites.
The reality is that there was a contractual arrangement with a supplier that stored the waste correctly, but stored too much of it. The Environment Agency is enforcing against that. We have put in place contingency plans within the trusts and set up alternative provision in the form of a contract with Mitie. The key strategic objective of ensuring that NHS operations continue has been secured.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Minister for the prompt action that he has taken since being notified of this situation. Will he reassure people in the community and in community settings that this issue will not affect their safety?
Stephen Barclay
The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.
Dr Philippa Whitford (Central Ayrshire) (SNP)
This situation does indeed sound graphic and horrific. Equally, I recognise that much of this waste will be cytotoxic, including drugs and syringes. We are talking about materials that are contaminated with faeces, infectious material and blood. We are discussing five sites across England. HES also has two sites in Scotland, both of which have been checked and do not have overstorage.
We hear that HES was served with 13 warning notices and two compliance notices over the past year. If that information was not accelerated up to the Department of Health, should it have been? HES says that it has been reporting its issue with incineration to regulators for quite a long time, yet the Minister says that there is no issue of capacity, so could not the Department have responded by directing HES to all this extra incineration capacity that apparently exists? As more local authorities are going towards zero-waste and incinerating material that would have been in landfill, the pressure will increase. There is probably ageing infrastructure and a need to expand, so do the Government plan a waste incineration strategy?
Stephen Barclay
The hon. Lady is absolutely right that HES has sites in Scotland; I think there are four. The Scottish Environment Protection Agency has been conducting regular site inspections and we are looking closely at the situation there—not least regarding the movement of waste from one site to another. However, she is correct that we are not aware of any specific issues at those sites.
The primary purpose of enforcement notices has been to encourage the company back into compliance. That has been the focus of the Environment Agency. The reason for the partial suspension in Normanton has been the unwillingness of the company to respond. Some notices are for what might be seen as relatively minor issues such as documentation, but obviously some relate to the overstorage on these sites.
Rebecca Pow (Taunton Deane) (Con)
I am pleased that new contracts have been signed and enforcement action has been taken—and quickly—but what is really important are the lessons learned, so will the Minister expand on that? While this is a sensitive matter—understandably, it evokes all kinds of concerns for the public—will the Minister assure us that there has been no risk to patients at any time or indeed to the wider public from this most concerning of issues?
Stephen Barclay
I am grateful to my hon. Friend for her question, and I am happy to give her constituents an assurance that there has been no risk to patients at any point during this time. As for lessons learned, clearly we will need to look at some of the lessons, particularly what triggers a breach of contract. A series of contracts were held by a wide number of trusts with the supplier, and it is important that we look at what the notification periods are, what the monitoring and enforcement processes are, and what powers there are under the terms of the contract to ensure that the company is acting as it should.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
We still do not have the basic facts about what medical waste is being held at the Normanton site, how far over the environmental limits it currently is, and what the timetable is for compliance. Perhaps the Minister would share that information with us. Does he not accept that it is a basic principle that, when dealing with any kind of public health or environmental health risk or incident, proper, full, factual information is provided to the public and the community at the earliest possible opportunity? You do not hide behind contractual negotiations. Does he accept that there is nothing in the contract negotiations that would have prevented him or the Health Secretary from providing some basic facts about those risks much, much earlier than today?
Stephen Barclay
On the split to which the right hon. Lady referred between clinical waste and other waste at the Normanton site—she rightly focused on that for her constituents—just under a third of the flow of waste to the site is clinical. Just over two thirds, in my understanding, is non-clinical. It is not the case that all the waste on the Normanton site is clinical waste. As I have mentioned, some media reports about what the term “clinical waste” constitutes are slightly different from the reality.
As for notification, I set that out in my written ministerial statement and in my comments today. The key focus is on maintaining the continuity of operations and service within the NHS trusts so that we are not in a position where clinical waste cannot be cleared from them. That is the focus, and that is why, given the commercial negotiations and the contingency arrangements that have been put in place, we came to the House today, and not at an earlier point.
Mr Philip Hollobone (Kettering) (Con)
In the end, the system has worked. There has been no back-up of clinical waste in hospitals—it has just been overstored in these sites. However, it is worrying, if it is true, that 13 warning notices and two compliance notices were issued to the company. Does the Minister think that he should be alerted earlier by the Environment Agency if this sort of thing happens in future?
Stephen Barclay
My hon. Friend makes a valid point about the lessons to be learned from this. Part of what I would expect to look at as we move forward are questions about when the NHS was first made aware of this and what powers are available to enforce at an earlier stage. As I have mentioned, enforcement notices cover a spectrum of risk. Some of those risks are more technical in nature than others, so while there have been 13 notices, their enforcement encompasses a range of severity.
Liz Kendall (Leicester West) (Lab)
According to its most recent accounts, HES made a gross profit of over £15 million last year. What financial penalty will it suffer because of its gross incompetence?
Stephen Barclay
The first financial penalty it has suffered is the prompt action we took over the weekend, with 15 NHS trusts cancelling those contracts and moving across. There is a clear financial penalty in that loss of business. As for fines, that is a matter of legal process, through the Environment Agency, in the normal way. That is not an NHS matter. The focus for the NHS is on maintaining continuity of service.
Rachel Maclean (Redditch) (Con)
The Minister will be aware that my constituents want to be assured that their operations in Redditch and Worcester will be able to continue as normal. Can he give them that assurance?
Mary Creagh (Wakefield) (Lab)
The Government like to talk tough on waste criminals, but here we have waste criminals storing 350 tonnes of clinical waste illegally—five times the amount to be compliant—at their site in Normanton, and despite the Minister being told about this on 31 July, neither the local MP nor constituents were informed. Cobra was informed. A criminal investigation is now under way into the company. Can he ensure that not a single acute hospital trust will lose one penny piece as a result of this criminal negligence?
Stephen Barclay
The hon. Lady raises several points. On the 350 tonnes of waste, I clarified the flow of that waste in my comments to the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) and I said that not all of it is clinical. I was not personally told on 31 July. I set out in my written statement when the NHS and then Ministers were told.
The question about whether there is any cost to NHS trusts is a very valid one for all constituency MPs who wish to understand the situation. The contingency cost—for example, from the additional capacity being put in place at trusts—will be borne centrally by the NHS family, and the cost of processing clinical waste will be borne by NHS trusts, as it has been to date.
Kevin Foster (Torbay) (Con)
I welcome the action the Minister has taken to terminate the contracts with this company, given its clear breaches and failure to deliver what it said it would. In his statement, he referred to the capacity for clinical waste incineration. Can he give us further detail about how he satisfied himself that there is capacity in each region? Clearly, these are specialist facilities, and having to transport waste could have a knock-on effect.
Stephen Barclay
I should clarify that it is not me personally who has terminated these contracts. These contracts with HES are held by the trusts themselves, and therefore it is a decision taken by those trusts.
As I said earlier, there is significant additional capacity within the incinerator landscape to process the waste generated by this contract, and therefore the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid. To be clear, HES produces 595 tonnes of waste a month that goes to incineration, and the NHS identified 2,269 tonnes of incineration capacity, so reports that there is a lack of capacity in the market are not valid.
Wes Streeting (Ilford North) (Lab)
I learned from the Health Service Journal that Barking, Havering and Redbridge University Hospitals NHS Trust was one of those affected. It is totally unacceptable that clearly one of Ministers’ objectives was to cover things up for as long as possible to save their own blushes because of the failure of a Government contractor. Members of this House should not learn of such events from the media. We should hear it from Ministers via the Dispatch Box or the relevant Select Committee—or there is such a thing as email.
Ministers have announced that £1 million of contingency funding is to be made available to support trusts affected. Will that be met from existing departmental budgets, or will money be allocated by the Treasury? Further to the point made by my hon. Friend the Member for Leicester West (Liz Kendall), surely it should be the failing contractor that coughs up £1 million, if not more. It should not come from taxpayers.
Stephen Barclay
We all learn things on a regular basis from the HSJ, but it seems misplaced to suggest that the hon. Gentleman should have been told about this when we were ensuring continuity of service and putting in place alternative arrangements to ensure that operations could continue at Barking and other hospitals. I have already addressed that point.
As I said, some of the cost—the contingency cost—will be absorbed centrally. The normal cost of clearing clinical waste was borne by the trusts before and will continue to be borne by the trusts.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I welcome the fact that there has been no gap in service provision and no public health risk and that the Minister has confirmed that nobody’s operation has been delayed because of this build-up of clinical waste, but it is still concerning that the contract was not properly delivered. How long has he given the site to return to compliance and what action is he taking to supervise the remaining contracts?
Stephen Barclay
The key issue for performance under the contracts is what, contractually, the legal requirements on HES are and whether those contractual terms have been breached. Part of the lessons learned is to look at whether contractual enforcement powers are sufficient. In terms of moving forward in respect of the other HES sites, that will depend on the contracts that the supplier has and whether it is in breach of those contracts or of enforcement action from the Environment Agency. To date, the Environment Agency has served one partial suspension, on the Normanton site. As I referred to, the Environment Agency was at the other site over the weekend. This is an area of significant scrutiny, but it will be for the Environment Agency to determine whether the company is not in compliance with its permits.
Maria Eagle (Garston and Halewood) (Lab)
So far, the Minister appears to have been far more interested in contractual arrangements than in public accountability. Can he explain how come Cobra has met and this House has not been informed of it? This House should be informed about Cobra meetings as soon as possible after they are finished.
Stephen Barclay
I am not sure about the exact protocols for when Cobra should and should not be reported, but given that it usually deals with highly confidential matters, I would have thought that not every issue should necessarily be reported in the first instance. We have been focused not on contractual niceties, but on ensuring that the NHS continues to deliver first-class services. As I referred to earlier, this is the first opportunity we have had following the conference recess to notify the House, following the contractual arrangements being made.
Tom Pursglove (Corby) (Con)
Will my hon. Friend confirm that the backlog of waste will be dealt with speedily, in accordance with the requirements of the law and with appropriate supervision?
Stephen Barclay
I very much share my hon. Friend’s desire for the backlog to be cleared as speedily as possible. As I referred to a moment ago, this is an area of scrutiny for the Environment Agency, and it is important that the company complies with its legal requirements and ensures that the level of waste is in line with its permits as soon as possible.
Nic Dakin (Scunthorpe) (Lab)
Hospitals such as Scunthorpe general cannot run effectively without the safe and secure disposal of clinical waste, which is exactly why it is important that the Minister has made the comments that he has today. Northern Lincolnshire and Goole trust quite properly put in place local contingencies, because obviously it could not rely on things being sorted out. It now looks as though contingencies are sorted nationally, so can he be very clear that local trusts will not face a penny more of extra costs as a result?
Stephen Barclay
The hon. Gentleman raises a fair point, and I want to be clear about the distinction. Additional cost arising from the contingency arrangement—for example, putting in place extra storage on the trust’s sites—will not be an additional cost on the trust. I hope that that will reassure him, although I do not want to suggest to him that there will be no financial impact on trusts, because the requirement to clear clinical waste sits with the trust. That is why the trusts themselves had contracts with the supplier. The ongoing arrangements are likely to mean some increased cost, as the new supplier comes on board. That will fall to the trust, but not the contingency element.
Baby Loss Awareness Week
Steve Barclay Excerpts(7 years, 8 months ago)
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The Minister for Health (Stephen Barclay)
May I join colleagues across the House in paying tribute to my hon. Friend the Member for Eddisbury (Antoinette Sandbach) for securing this debate on Baby Loss Awareness Week? It is particularly appropriate, as today marks the start of the 2018 campaign. How we reduce the numbers of baby losses is an issue that unites the House, as has been very much reflected in the tenor of this evening’s debate. May I also say to my hon. Friend the Member for Colchester (Will Quince) that I am sure that all in the Chamber will be thinking of Robert and him on Friday, as he marks that particularly poignant fourth anniversary?
My hon. Friend the Member for Eddisbury raised a number of important points in her speech, including about the national bereavement care pathway and the ongoing investigations at the three hospitals in England and Wales. I will address those shortly. She is right to recognise the higher profile that this issue has received in recent years, this being the third such debate in the last three years. That is very much testament to the work of the all-party group on baby loss and in particular my hon. Friends the Members for Eddisbury, for Colchester and for Banbury (Victoria Prentis), who is not in her place, the hon. Member for Washington and Sunderland West (Mrs Hodgson), to whom my opposite number correctly paid tribute and who very much moved the House in a previous debate, and the hon. Member for North Ayrshire and Arran (Patricia Gibson), who quite rightly spoke of Kenneth, who is very much in her thoughts and reflects much of the work that she has done in this place. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) also made the point very well that this issue affects the family as a whole, including grandparents.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
I join the Minister in congratulating all the Members who have brought this issue to the Floor of the House today and especially the hon. Member for Eddisbury (Antoinette Sandbach) on securing the debate. The Minister has talked about the family, and we have heard much about the emotional journey for mothers and fathers who experience loss. We are living now in a more equal society, in which more lesbian women are becoming mothers, and they, too, experience loss through the death of a baby or young child. Will he ensure that that is reflected in the opportunities to learn about the lived experience of mothers, to which my hon. and good Friend the Member for North Ayrshire and Arran (Patricia Gibson) referred, whether they have a husband or a wife?
Stephen Barclay
The hon. Gentleman makes a valid point. He will have noticed that my colleague the Minister for Women and Equalities was in the Chamber for part of the debate, and I am sure that those sentiments are very much reflected in the work that she is doing. I am very happy to work with him to ensure that the Government’s approach takes those points on board.
Before coming to the wider areas of progress and considering what still needs to be done to deliver the improvements that we all want to see, I will address some of the specific comments made by Members across the House. My hon. Friend the Member for Colchester rightly mentioned the inconsistency between trusts. I understand that Sands is asking for the national bereavement care pathway to be included in the CQC’s inspection framework for maternity. I am happy to write to the CQC to request that this becomes part of the inspection regime. I think that can build on the point my hon. Friend the Member for Eddisbury made about recent progress in Medway.
My hon. Friend the Member for Colchester also suggested a training module for midwives on bereavement. Again, I am happy to write to Professor Ian Cummings, the chief executive of Health Education England, on that point and to share the correspondence with the all-party parliamentary group. One of the objectives of the pregnancy loss review is to recommend options to improve maternity care practice for parents who experience baby loss, so that is part of that work.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who so often brings her clinical expertise to debates, raised the issue of travel costs. The Patient Advice and Liaison Service can advise on eligibility for schemes, as this tends to be specific to individual trusts, but it can apply in certain instances, particularly when linked to benefit entitlement.
My hon. Friend the Member for Gloucester (Richard Graham), who is no longer in his place, mentioned the important work of the hospital chaplaincy, and I think that Members on both sides of the House recognise the support that chaplains can offer following baby loss. Indeed, the bereavement care pathway guidance recommends offering parents contact with the chaplaincy team, so the role of the chaplaincy will be given greater visibility as the pathway is rolled out across more trusts.
The hon. Member for Ellesmere Port and Neston (Justin Madders) rightly mentioned midwife numbers. We recognise that the workforce do face pressure, as is reflected in the 25% increase in the number of midwifery training places that the Government are committed to. Indeed, numbers have increased in each of the last four years. But he makes a valid point and we are focused on dealing with the workforce pressures.
As a number of Members have recognised, the Government have a clear ambition to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries that occur during or soon after birth by 2025, and to achieve at least a 20% reduction in these rates by 2020. Since the launch of the national maternity ambition in 2015, the Government have introduced a range of evidence-based interventions to support maternity and neonatal services, under the leadership of the maternity safety champions, who are responsible for promoting safety in their organisations.
I am pleased to report that we remain on course to achieve our 2020 ambition. The stillbirth rate in England fell from 5.1 to 4.1 per 1,000 births between 2010 and 2017, representing a decrease of almost 20%, which equates to 827 fewer stillbirths. We currently have the lowest stillbirth rate on record. The neonatal mortality rate also fell from 2.9 to 2.8 per 1,000 live births between 2010 and 2016. Many Members will be aware that multiple pregnancies are at greater risk of perinatal death, so I welcome the findings in a recent MBRRACE-UK report showing that the stillbirth rate for UK twins almost halved between 2014 and 2016, with a fall of 44%. In addition, neonatal deaths among UK twins has dropped by 30%.
There are areas of progress, but as my hon. Friend the Member for Colchester rightly said, part of the focus of today’s debate is on the areas where we need to improve, not just on the areas where there has been progress. One key area relates to ethnic minority groups, where we know stillbirth and neonatal mortality rates are increasing rather than decreasing. The Government continue to work with others to develop and implement policies to tackle such inequalities. This is an area on which we would be very happy to work with the APPG. It is an issue of concern to Members on all sides of the House.
A number of Members raised the role of the Healthcare Safety Investigation Branch and the importance of identifying where there are lessons to be learned. My hon. Friend the Member for Sleaford and North Hykeham is right that clinicians must be free to speak up where mistakes have been made. Indeed, the former Secretary of State championed that in his work on patient safety. It is also why we are improving investigations into term stillbirths. There is a role for the Royal College of Obstetricians and Gynaecologists in terms of the Each Baby Counts programme. Considerable work is under way, part of which, as my hon. Friend the Member for Eddisbury recognised, is on ensuring that in respect of the investigations at the specific hospitals she mentioned the appropriate lessons are learned. She will appreciate that, as they are live investigations, I cannot comment on them in detail.
Evidence demonstrates that women who have a midwife-led continuity model of care are less likely to suffer baby loss. In March, the Secretary of State pledged that most women will receive such care throughout pregnancy, labour and birth by 2021, with 20%, or about 130,000 women, benefiting by 2019. This will help to bolster maternity safety and further improve care standards.
It is positive to see the impact that many initiatives can have on reducing baby loss, but the Government recognise the need to improve the care bereaved families experience. That is why the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister with responsibility for maternity care, recently announced full funding of £106,000 to the charity Sands to continue the roll-out of the national bereavement care pathway. I hope that reassures my hon. Friend the Member for Eddisbury that the value of the care pathway is very much recognised within Government. As my hon. Friend mentioned, this initiative has seen a positive response from parents and medical professionals, with 77% of professionals saying bereavement care has improved.
On pregnancy loss and the pregnancy loss review, which my Department commissioned earlier this year, the review has been considering the question of whether legislation should provide new rights to bereaved parents to register pre-24-week pregnancy loss, as well as investigating the impact of such losses on families and how care can be improved for parents who experience it. That review is currently scheduled to be completed in the new year. A number of very important points on that pre-24-week period were raised.
The Department of Health and Social Care and the Ministry of Justice have been consulting with coroners, patients’ groups and charities to consider the role of the coroner in relation to stillbirths. This is about ensuring that bereaved parents are given a full account of the events leading up to the loss of their baby and that important lessons are learned. The hon. Member for Nottingham South (Lilian Greenwood) in particular made a point on the role of coroners in an intervention. This work will continue over the coming months.
In conclusion, progress is being made. I think that was recognised in a number of the speeches this evening, particularly in respect of: the commitment to fund in full the national roll-out of the bereavement care pathway in 2018-19, for which guidance and resources have been released today; the ongoing pregnancy loss review, which is due to report in early 2019; the work being done by the Department of Health and Social Care and the Ministry of Justice regarding the role of the coroner in investigating stillbirths; the progression of the private Member’s Bill, which will have its Third Reading on 26 October, promoted by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on those last two issues; and the recent passage of the Parental Bereavement (Leave and Pay) Act 2018, mentioned by a number of Members, through the work of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake).
I would like to close by making it clear that the Government are actively listening to concerns on this issue. This issue unites the House. On behalf of the Government, I very much look forward to working with the APPG, and Members across the House, to ensure that the progress we have seen in recent years continues, so that we can all tackle the most appalling loss that the families we represent can face.
Clinical Waste Update
Steve Barclay Excerpts(7 years, 8 months ago)
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The Minister for Health (Stephen Barclay)
This statement is to update the House on an issue concerning clinical waste collection and disposal for hospitals and other public services.
On 31 July, the Environment Agency notified central Government of an issue concerning clinical waste collection and disposal for hospitals and other public services provided by the company, Healthcare Environmental Services (HES). In this instance, the primary concern was that too much waste was being held in a number of waste storage and treatment sites by a contractor, Healthcare Environment Services (HES). While the waste was stored securely, it was not being processed and disposed of within the correct regulatory timescales. At no point has there been an impact on public health or any delay to the ability of the NHS to carry out operations.
The Department of Health and Social Care, DEFRA, the Cabinet Office, NHS England, NHS Improvement and the Environment Agency have worked together to resolve these issues. From the outset, the Government’s priority have been to ensure measures were put in place so that trusts could continue operating as normal should there be any disruption to waste collection and disposal. This objective has been achieved. The Department of Health and Social Care has worked with the NHS to help trusts put these contingency plans in place. A major part of these contingency plans concerned contractual discussions with HES and other providers which were commercially sensitive.
Following the Environment Agency’s issuing of a partial closure to HES’s Normanton site, on 3 October the regulator, NHS Improvement, issued a letter to HES to advise them that they had concerns in respect of services provided to trusts. To give HES an opportunity to set out how it was complying with its legal and contractual obligations, NHSI gave HES 48 hours to provide evidence that they were operating within legal and contractual parameters and set out a number of threshold levels. NHSI concluded that HES failed to demonstrate that they were operating within their contractual limits. Consequently, 15 NHS trusts served termination notices to HES formally to terminate their contracts at 4 pm on Sunday 7 October. In parallel, the Department of Health and Social Care, the Cabinet Office, NHS Improvement and the affected trusts have negotiated a new contract with Mitie to step in and replace this service. This contract was enacted, following the termination of the contract with HES, and Mitie have been fully operational across all affected trust sites from Monday morning.
Throughout, the Government’s priority have been to ensure measures were put in in place so that NHS trusts can continue operating as normal. No gap in service provision has been reported and we are working to ensure that this remains the case.
The Environment Agency are taking enforcement action against HES to clear the excess waste from their sites and bring the company back into compliance with their permits. As part of this enforcement activity, the Environment Agency have partially suspended the company’s permit at their Normanton site. This will prevent HES from accepting any more incinerator-only waste, as the company focuses on clearing the backlog of waste on-site. The Environment Agency are also progressing with enforcement action at the other non-compliant sites. This includes following up the first enforcement notice for the HES Newcastle site. If the site does not become compliant, the likely next stage is a partial suspension to prevent the acceptance of incinerator-only waste at Newcastle. It is the company’s responsibility to clear its sites and operate legally.
I am updating the House on this situation now, given that new contracts have been signed following the conclusion of the commercially sensitive process. I can confirm that NHS services continue to operate as normal. We are ensuring that there are contingency plans in place in case of any disruption, and that there is absolutely no risk to the health of patients or the wider public. The Government are working with the Environment Agency and NHS to ensure lessons are learnt, and we are reviewing how contracts will be awarded in the future.
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